gms | German Medical Science

Objective: Acquiring operative skills in the course of a structured neurosurgery residency training program is vital to safely operating patients autonomously upon board certification. We tested the hypothesis that the complication rates and outcome of microscopic lumbar spinal stenosis (LSS) decompression done by supervised residents are not inferior to those of board-certified faculty neurosurgeons (BCFN).

Method: Retrospective single-center study performed at a Swiss teaching hospital comparing consecutive patients undergoing surgery for LSS by a supervised neurosurgery resident (teaching cases) to a consecutive series of patients operated on by a BCFN (non-teaching cases). The primary endpoint was occurrence of complications during surgery. Secondary endpoints were patients’ clinical outcomes 4 weeks after surgery, categorized into a binary responder and non-responder variable, occurrence of postoperative complications, need for re-do surgery, and clinical outcome until the last follow-up (FU).

Results: In a total of n=471 operations, n=194 (41.2%) were teaching cases and n=277 (58.8%) were non-teaching cases. A longer operation time (single-level procedures: mean 100.0 vs. 83.2min, p<0.001) was recorded for teaching cases, while estimated blood loss was lower (single-level procedures: mean 109.9 vs. 117.0ml, p=0.409). In multivariate analysis, supervised residents were as likely as BCFN to have an intraoperative complication (OR 0.92, 95%CI 0.41-2.04, p=0.835). They were as likely as BCFN to achieve a favorable 4-week response to surgery (OR 1.82, 95% CI 0.79-4.15, p=0.155). Until final FU the likelihood for patients in the teaching group to suffer from postoperative complications (OR 1.07, 95% CI 0.46-2.49, p=0.864) or require re-do surgery (OR 0.68, 95% CI 0.31-1.52, p=0.358) was similar to that of the non-teaching group.

Conclusions: Complication rates and short- and mid-term outcomes following LSS decompression were comparable for patients operated on by supervised neurosurgery residents and by senior neurosurgeons. Our data thus indicates that a structured neurosurgical hands-on training including LSS decompression is safe for patients. The results may stimulate an important discussion about early training safety concerns. This discussion may be necessary in the context of present developments concerning work time and resident exposure to surgery.