title: Endoscopic endonasal pituitary surgery: impact of surgical education on operation length and patient morbidity.
abstract: Objectives To determine the difference in operative times and associated complications for cases performed solely by attending-level surgeons versus cases assisted by surgeons-in-training for endoscopic endonasal pituitary surgeries. Design Retrospective chart review. Setting Tertiary-care academic medical center. Participants A total of 228 patients having undergone endoscopic endonasal pituitary surgery from 2005 to 2011. Main Outcome Measure Duration of surgery comparing attending only (AO) and trainee-assisted (TA) surgeries. Results Thirty-seven (19%) of 198 cases were identified as AO surgeries, the remaining 161 (81%) were TA. Operative times (minutes) for the AO group were significantly shorter than the TA group (149.1 ± 54.8 vs 219.5 ± 83.7, p < 0.001). The AO group had fewer intraoperative cerebrospinal fluid leaks (30% vs 39%, p = 0.318), decreased estimated blood loss (408 mL vs 523 mL, p = 0.176), fewer postoperative complications (27% vs 37%, p = 0.268), and shorter length of stay (3.5 vs 4.3 days, p = 0.294). Conclusions This is the first study in otolaryngology or neurosurgery to compare operative times and outcomes for AO versus TA cases at a single academic institution. Operative times were significantly decreased and a trend toward a decrease in patient morbidity was noted for cases performed solely by attendings. The valuation of teaching activities in the operating room is a necessary first step toward optimizing the allocation of resources and funding of surgical education.
authors.affiliation: Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.
authors.forename: Raj C
authors.initials: RC
authors.lastname: Dedhia
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Lord
authors.forename: Carlos D
authors.initials: CD
authors.lastname: Pinheiro-Neto
authors.forename: Juan C
authors.initials: JC
authors.lastname: Fernandez-Miranda
authors.forename: Eric W
authors.initials: EW
authors.lastname: Wang
authors.forename: Paul A
authors.initials: PA
authors.lastname: Gardner
authors.forename: Carl H
authors.initials: CH
authors.lastname: Snyderman
keywords: endoscopic endonasal approach; pituitary surgery; residency training; skull base surgery; surgical education