Effect of an additional neurosurgical resident on procedure length, operating room time, estimated blood loss, and post-operative length-of-stay

Anthony V. Nguyen, William S. Coggins, Rishabh R. Jain, Daniel W. Branch, Randall Z. Allison, Ken Maynard, Rishi Rajiv Lall

Research output: Contribution to journalArticle

Abstract

Introduction: Neurosurgical residency training is costly, with expenses largely borne by the academic institutions that train residents. One expense is increased operative duration, which leads to poorer patient outcomes. Although other studies have assessed the effect of one resident assisting, none have investigated two residents; thus, we sought to investigate if two residents versus one scrubbed-in impacted operative time, estimated blood loss (EBL), and length-of-stay (LOS). Methods: In this retrospective review of patients who underwent a neurosurgical procedure involving one or two residents between January 2013 and April 2016, we performed multivariable linear regression to determine if there was an association between resident participation and case length, operating room time, EBL, and LOS. We also included patient demographics, attending surgeon, day of the week, start time, pre-operative LOS, procedure performed, and other variables in our model. Only procedures performed at least 40 times during the study period were analyzed. Results: Of 860 procedures that met study criteria, 492 operations were one of six procedures performed at least 40 times, which were anterior cervical discectomy and fusion, cerebrospinal fluid (CSF) shunt insertion, CSF shunt revision, lumbar laminectomy, intracranial hematoma evacuation, and non-skull base, supratentorial parenchymal brain tumor resection. An additional resident was associated with a 35.1-min decrease (p =.01) in operative duration for lumbar laminectomies. However, for intracranial hematoma evacuations, an extra resident was associated with a 24.1 min increase (p =.03) in procedural length. There were no significant differences observed in the other four surgeries. Conclusion: An additional resident may lengthen duration of intracranial hematoma evacuations. However, two residents scrubbed-in were associated with decreased lumbar laminectomy duration. Overall, an extra resident does not increase procedural duration, total operating room utilization, EBL, or post-operative LOS. Allowing two residents to scrub in may be a safe and cost-effective method of educating neurosurgical residents.

Original languageEnglish (US)
JournalBritish Journal of Neurosurgery
DOIs
StateAccepted/In press - Jan 1 2019

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Operating Rooms
Length of Stay
Laminectomy
Cerebrospinal Fluid Shunts
Hematoma
Operative Time
Neurosurgical Procedures
Diskectomy
Internship and Residency
Brain Neoplasms
Linear Models
Demography
Costs and Cost Analysis

Keywords

  • Neurosurgery
  • neurosurgical training
  • operating times
  • operative experience
  • outcome
  • reforms to training

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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Effect of an additional neurosurgical resident on procedure length, operating room time, estimated blood loss, and post-operative length-of-stay. / Nguyen, Anthony V.; Coggins, William S.; Jain, Rishabh R.; Branch, Daniel W.; Allison, Randall Z.; Maynard, Ken; Lall, Rishi Rajiv.

In: British Journal of Neurosurgery, 01.01.2019.

Research output: Contribution to journalArticle

Nguyen, Anthony V. ; Coggins, William S. ; Jain, Rishabh R. ; Branch, Daniel W. ; Allison, Randall Z. ; Maynard, Ken ; Lall, Rishi Rajiv. / Effect of an additional neurosurgical resident on procedure length, operating room time, estimated blood loss, and post-operative length-of-stay. In: British Journal of Neurosurgery. 2019.
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AU - Nguyen, Anthony V.

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AU - Jain, Rishabh R.

AU - Branch, Daniel W.

AU - Allison, Randall Z.

AU - Maynard, Ken

AU - Lall, Rishi Rajiv

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AB - Introduction: Neurosurgical residency training is costly, with expenses largely borne by the academic institutions that train residents. One expense is increased operative duration, which leads to poorer patient outcomes. Although other studies have assessed the effect of one resident assisting, none have investigated two residents; thus, we sought to investigate if two residents versus one scrubbed-in impacted operative time, estimated blood loss (EBL), and length-of-stay (LOS). Methods: In this retrospective review of patients who underwent a neurosurgical procedure involving one or two residents between January 2013 and April 2016, we performed multivariable linear regression to determine if there was an association between resident participation and case length, operating room time, EBL, and LOS. We also included patient demographics, attending surgeon, day of the week, start time, pre-operative LOS, procedure performed, and other variables in our model. Only procedures performed at least 40 times during the study period were analyzed. Results: Of 860 procedures that met study criteria, 492 operations were one of six procedures performed at least 40 times, which were anterior cervical discectomy and fusion, cerebrospinal fluid (CSF) shunt insertion, CSF shunt revision, lumbar laminectomy, intracranial hematoma evacuation, and non-skull base, supratentorial parenchymal brain tumor resection. An additional resident was associated with a 35.1-min decrease (p =.01) in operative duration for lumbar laminectomies. However, for intracranial hematoma evacuations, an extra resident was associated with a 24.1 min increase (p =.03) in procedural length. There were no significant differences observed in the other four surgeries. Conclusion: An additional resident may lengthen duration of intracranial hematoma evacuations. However, two residents scrubbed-in were associated with decreased lumbar laminectomy duration. Overall, an extra resident does not increase procedural duration, total operating room utilization, EBL, or post-operative LOS. Allowing two residents to scrub in may be a safe and cost-effective method of educating neurosurgical residents.

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KW - outcome

KW - reforms to training

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