title: Impact of resident participation on morbidity and mortality in neurosurgical procedures: an analysis of 16,098 patients.
abstract: OBJECTIVE
  The authors sought to determine the impact of resident participation on overall 30-day morbidity and mortality following neurosurgical procedures.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who had undergone neurosurgical procedures between 2006 and 2012. The operating surgeon(s), whether an attending only or attending plus resident, was assessed for his or her influence on morbidity and mortality. Multivariate logistic regression, was used to estimate odds ratios for 30-day postoperative morbidity and mortality outcomes for the attending-only compared with the attending plus resident cohorts (attending group and attending+resident group, respectively).
  
  
  RESULTS
  The study population consisted of 16,098 patients who had undergone elective or emergent neurosurgical procedures. The mean patient age was 56.8 ± 15.0 years, and 49.8% of patients were women. Overall, 15.8% of all patients had at least one postoperative complication. The attending+resident group demonstrated a complication rate of 20.12%, while patients with an attending-only surgeon had a statistically significantly lower complication rate at 11.70% (p < 0.001). In the total population, 263 patients (1.63%) died within 30 days of surgery. Stratified by operating surgeon status, 162 patients (2.07%) in the attending+resident group died versus 101 (1.22%) in the attending group, which was statistically significant (p < 0.001). Regression analyses compared patients who had resident participation to those with only attending surgeons, the referent group. Following adjustment for preoperative patient characteristics and comorbidities, multivariate regression analysis demonstrated that patients with resident participation in their surgery had the same odds of 30-day morbidity (OR = 1.05, 95% CI 0.94-1.17) and mortality (OR = 0.92, 95% CI 0.66-1.28) as their attending only counterparts.
  
  
  CONCLUSIONS
  Cases with resident participation had higher rates of mortality and morbidity; however, these cases also involved patients with more comorbidities initially. On multivariate analysis, resident participation was not an independent risk factor for postoperative 30-day morbidity or mortality following elective or emergent neurosurgical procedures.
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Bydon
authors.forename: Nicholas B
authors.initials: NB
authors.lastname: Abt
authors.forename: Rafael
authors.initials: R
authors.lastname: De la Garza-Ramos
authors.forename: Mohamed
authors.initials: M
authors.lastname: Macki
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Witham
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
authors.forename: Judy
authors.initials: J
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D058996:Quality Improvement; D012959:Socioeconomic Factors; D066231:Surgeons / Q000706:statistics & numerical data
keywords: ACS = American College of Surgeons; BMI = body mass index; NSQIP; NSQIP = National Surgical Quality Improvement Program; SSI = superficial surgical site; attending; morbidity; mortality; neurosurgery; resident