How does the participation of a resident surgeon in procedures for small intracranial aneurysms impact patient outcome?
OBJECTIVE
In this paper the authors' goal was to evaluate whether resident neurosurgeons participating in entry-level aneurysm surgery have a negative impact on patient outcomes.


METHODS
The authors searched the database for entry-level aneurysm surgeries (that is, those < or =10 mm and located in the internal carotid artery [beyond the paraclinoid segment] and middle cerebral artery) performed in 1991 through 2005. The presence or absence of an advanced resident (in his/her last 3 years of residency) was noted. The analysis was examined in 3-year quintiles. A total of 355 cases (196 with resident participation and 159 without) were evaluated. Permanent adverse outcomes were seen in 11 patients (3.1% of the total study population), all due to branch artery occlusion. The incidence of permanent adverse outcomes in the first 3 years was 10.7% and 2.4% thereafter. This difference was statistically significant (p = 0.015). There was no difference in the incidence of adverse outcomes when comparing surgery performed with and without participation of an advanced resident.


CONCLUSIONS
In this study the authors have demonstrated a learning curve in this series of patients. This study also suggests that involving residents in the repair of small unruptured aneurysms will not compromise patient care. In addition, patients can be informed that the team approach to their surgery is at least as good as having the experienced surgeon performing all aspects of the surgery.
Morgan
Michael K
MK
School of Advanced Medicine, Macquarie University, Sydney, Australia. kerin@ihug.com.au
Assaad
Nazih N
NN
Davidson
Andrew S
AS
D002340:Carotid Artery Diseases / Q000601:surgery; D020212:Carotid Artery Injuries / Q000209:etiology; D016208:Databases, Factual; D006801:Humans; D007396:Internship and Residency; D002532:Intracranial Aneurysm / Q000601:surgery*; D007858:Learning; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome