Aim: To investigate the safety and efficacy of surgical education for neurosurgical residents
in the evacuation of chronic subdural hematomas (cSDH) by burr hole trepanation.
Methods: This is a retrospective analysis of prospectively collected data on consecutive patients
receiving burr hole trepanation for uni- or bilateral cSDH. Patients operated by a
supervised neurosurgery resident (teaching cases) were compared with patients operated
by a board-certified faculty neurosurgeon (nonteaching cases). The primary end point
was surgical revision for any reason until last follow-up. The secondary end point
was occurrence of any complication until last follow-up. Clinical status, type of
complications, mortality, length of surgery (LOS), and hospitalization (LOH) were
tertiary end points.
Results: A total of n = 253 cases were analyzed, of which n = 217 (85.8%) were teaching and n = 36 (14.2%) nonteaching cases. The study groups were balanced in terms of age, sex,
surgical risk (ASA score), and preoperative status (Karnofsky Performance Scale, modified
Rankin Scale, National Institute of Health Stroke Scale). The cohort was followed
for a mean of 242 days (standard deviation 302). In multivariate analysis, teaching
cases were as likely as nonteaching cases to require revision surgery (odds ratio
[OR] 0.65, 95% confidence interval [CI] 0.27—1.59, p = 0.348) as well as to experience any complication until last follow-up (OR 0.79,
95% CI 0.37–1.67, p = 0.532). Mean LOS was about 10 minutes longer in teaching cases (53.0 ± 26.1 min
vs 43.5 ± 17.8 min, p = 0.036), but LOH was similar. There were no group differences in clinical status,
mortality, and type of complication at discharge and last follow-up.
Conclusions: Burr hole trepanation for cSDH can be safely performed by supervised neurosurgical
residents enrolled in a structured training program, without increasing the risk for
revision surgery, perioperative complications, or worse outcome.
