Impact of Resident Participation on Outcomes After Single-Level Anterior Cervical Diskectomy and Fusion

Kim, Robert B.; García, Roxanna M.; Smith, Zachary A.; Dahdaleh, Nader S.

doi:10.1097/brs.0000000000001230

Cited by 37 publications

(24 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It remains unclear from our data, whether or not the decline in caseload during training translates into worse performance as a neurosurgeon, higher complication rates, or worse postoperative outcomes. Supervised surgical training does not increase complication rates or worsens outcome, as could be shown before [ 9 – 11 , 21 , 22 ]. However, potentially dangerous surgery performed by unexperienced surgeons without adequate supervision is unsafe and data from the USA shows an increase in complication rates and morbidity after caseloads were reduced by duty-hour restrictions [ 2 , 3 , 7 ].…”

Section: Discussionsupporting

confidence: 52%

Procedures performed during neurosurgery residency in Europe

Meling

Al-Amin²,

Al-Mahfoudh³

et al. 2020

Acta Neurochir

View full text Add to dashboard Cite

Background In a previous article (10.1007/s00701-019-03888-3), preliminary results of a survey, aiming to shed light on the number of surgical procedures performed and assisted during neurosurgery residency in Europe were reported. We here present the final results and extend the analyses. Methods Board-certified neurosurgeons of European Association of Neurosurgical Societies (EANS) member countries were asked to review their residency case logs and participate in a 31-question electronic survey (SurveyMonkey Inc., San Mateo, CA). The responses received between April 25, 2018, and April 25, 2020, were considered. We excluded responses that were incomplete, from non-EANS member countries, or from respondents that have not yet completed their residency. Results Of 430 responses, 168 were considered for analysis after checking in- and exclusion criteria. Survey responders had a mean age of 42.7 ± 8.8 years, and 88.8% were male. Responses mainly came from surgeons employed at university/teaching hospitals (85.1%) in Germany (22.0%), France (12.5%), the United Kingdom (UK; 8.3%), Switzerland (7.7%), and Greece (7.1%). Most responders graduated in the years between 2011 and 2019 (57.7%). Thirty-eight responders (22.6%) graduated before and 130 responders (77.4%) after the European WTD 2003/88/EC came into effect. The mean number of surgical procedures performed independently, supervised or assisted throughout residency was 540 (95% CI 424–657), 482 (95% CI 398–568), and 579 (95% CI 441–717), respectively. Detailed numbers for cranial, spinal, adult, and pediatric subgroups are presented in the article. There was an annual decrease of about 33 cases in total caseload between 1976 and 2019 (coeff. − 33, 95% CI − 62 to − 4, p = 0.025). Variables associated with lesser total caseload during residency were training abroad (1210 vs. 1747, p = 0.083) and female sex by trend (947 vs. 1671, p = 0.111), whereas case numbers were comparable across the EANS countries (p = 0.443). Conclusion The final results of this survey largely confirm the previously reported numbers. They provide an opportunity for current trainees to compare their own case logs with. Again, we confirm a significant decline in surgical exposure during training between 1976 and 2019. In addition, the current analysis reveals that female sex and training abroad may be variables associated with lesser case numbers during residency.

show abstract

Section: Discussionsupporting

confidence: 52%

Procedures performed during neurosurgery residency in Europe

Meling

Al-Amin²,

Al-Mahfoudh³

et al. 2020

Acta Neurochir

View full text Add to dashboard Cite

show abstract

“…Prior studies have utilized the ACS-NSQIP database to investigate the impact of resident involvement on adverse events and readmissions following orthopaedic surgery 6,8,14,17,18,24 ; however, these studies have largely been focused on spine surgery 8,17,18 and total joint arthroplasty. 6,14 The results of these studies have thus far been mixed in terms of the effects of resident involvement on outcomes and readmissions.…”

Section: Discussionmentioning

confidence: 99%

Resident Involvement in Shoulder Arthroscopy Is Not Associated With Short-term Risk to Patients

Basques

Saltzman

Mayer

et al. 2018

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background:Shoulder arthroscopy is a commonly performed, critical component of orthopaedic residency training. However, it is unclear whether there are additional risks to patients in cases associated with resident involvement.Purpose:To compare shoulder arthroscopy cases with and without resident involvement via a large, prospectively maintained national surgical registry to characterize perioperative risks.Study Design:Cohort study; Level of evidence, 3.Methods:The prospectively maintained American College of Surgeons National Surgical Quality Improvement Program registry was queried to identify patients who underwent 1 of 12 shoulder arthroscopy procedures from 2005 through 2012. Multivariate Poisson regression with robust error variance was used to compare the rates of postoperative adverse events and readmission within 30 days between cases with and without resident involvement. Multivariate linear regression was used to compare operative time between cohorts.Results:A total of 15,774 patients with shoulder arthroscopy were included in the study, and 12.3% of these had a resident involved with the case. The overall rate of adverse events was 1.09%. On multivariate analysis, resident involvement was not associated with increased rates of any aggregate or individual adverse event. There was also no association between resident involvement and risk of readmission within 30 days. Resident involvement was not associated with any difference in operative time (P = .219).Conclusion:Resident involvement in shoulder arthroscopy was not associated with increased risk of adverse events, increased operative time, or readmission within 30 days. The results of this study suggest that resident involvement in shoulder arthroscopy cases is a safe method for trainees to learn these procedures.

show abstract

“…The propensity score was estimated using a logistic regression model to balance the baseline covariates between the two groups. 14 For this study, one-to-one matching was used with a nearest neighbor matching without replacements, in which each case in the control group was matched with a unique case in the OVCF group based on the nearest propensity scores. Factors associated with frailty, such as age, sex, BMI, education level, and income, were considered as confounders, and used in the logistic regression analysis.…”

Section: Methodsmentioning

confidence: 99%

Prevalence of Frailty in Patients with Osteoporotic Vertebral Compression Fracture and Its Association with Numbers of Fractures

Kim

Park

et al. 2018

Yonsei Med J

View full text Add to dashboard Cite

PurposeTo assess the association between frailty and osteoporotic vertebral compression fracture (OVCF) and to evaluate the relationship between numbers of OVCFs and frailty.Materials and MethodsWe enrolled 760 subjects, including 59 patients (with OVCF) and 701 controls (without OVCF). Successful matching provided 56 patient-control pairs. We analyzed principal clinical and demographic information, which included sex, age, height, weight, body mass index (BMI), variable frailty phenotypes, and Oswestry Disability Index (ODI) and EuroQol 5-dimension questionnaire (EQ-5D) scores. The association between frailty and OVCF was ascertained. In addition, the degrees of disability and quality of life attributable to frailty were determined.ResultsThe prevalence of frailty was significantly higher in the OVCF group than in the control group (p<0.001). Most of the frailty phenotypes, such as exhaustion, physical inactivity, slowness, and handgrip strength, were also significantly observed in the OVCF group. Within the OVCF group, the participants with frailty had significantly higher disability and lower quality of life than those in a robust state (p<0.001 for ODI and EQ-5D). In addition, the multivariate logistic regression analysis demonstrated that the patients with low BMI [odds ratio (OR)=0.704; 95% confidence interval (CI), 0.543–0.913] and ≥3 fractures (OR=9.213; 95% CI, 1.529–55.501) within the OVCF group were associated with higher odds of frailty.ConclusionThe present study showed significant relationships between frailty and OVCF, severity of symptoms, and disability induced by OVCF. Furthermore, frailty could be a causal and/or resulting factor of OVCFs.

show abstract

Impact of Resident Participation on Outcomes After Single-Level Anterior Cervical Diskectomy and Fusion

Abstract: 3.

Cited by 37 publications

References 32 publications

Procedures performed during neurosurgery residency in Europe

Procedures performed during neurosurgery residency in Europe

Resident Involvement in Shoulder Arthroscopy Is Not Associated With Short-term Risk to Patients

Prevalence of Frailty in Patients with Osteoporotic Vertebral Compression Fracture and Its Association with Numbers of Fractures

Contact Info

Product

Resources

About