title: Impact of resident involvement in neurosurgery: an analysis of 8748 patients from the 2011 American College of Surgeons National Surgical Quality Improvement Program database.
abstract: OBJECTIVE
  This study evaluates the impact of resident presence in the operating room on postoperative outcomes in neurosurgery.
  
  
  METHODS
  The authors retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and identified all cases treated in a neurosurgery service in 2011. Propensity scoring analysis and multiple logistic regression models were used to reduce patient bias and to assess independent effect of resident involvement.
  
  
  RESULTS
  Of the 8748 neurosurgery cases identified, residents were present in 4529 cases. Residents were more likely to be involved in complex procedures with longer operative duration. The multivariate analysis found that resident involvement was not a statistically significant factor for overall complications (OR 1.116, 95% CI 0.961-1.297), surgical complications (OR 1.132, 95% CI 0.825-1.554), medical complications (OR 1.146, 95% CI 0.979-1.343), reoperation (OR 1.250, 95% CI 0.984-1.589), mortality (OR 1.164, 95% CI 0.780-1.737), or unplanned readmission (OR 1.148, 95% CI 0.946-1.393).
  
  
  CONCLUSIONS
  In this multicenter study, the authors demonstrated that resident involvement in the operating room was not a significant factor for postoperative complications in neurosurgery service. This analysis also showed that much of the observed difference in postoperative complication rates was attributable to other confounding factors. This is a quality indicator for resident trainees and current medical education. Maintaining high standards in postgraduate training is imperative in enhancing patient care and reducing postoperative complications.
authors.affiliation: Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago; and 
authors.forename: Seokchun
authors.initials: S
authors.lastname: Lim
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Parsa
authors.forename: Bobby D
authors.initials: BD
authors.lastname: Kim
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Rosenow
authors.forename: John Y S
authors.initials: JY
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000193:education / Q000706:statistics & numerical data*; D019635:Neurosurgical Procedures / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology; D058996:Quality Improvement / Q000706:statistics & numerical data* / Q000639:trends; D020379:Risk Adjustment; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: ACS-NSQIP = American College of Surgeons National Surgical Quality Improvement Program; ASA = American Society of Anesthesiologists; American College of Surgeons National Surgical Quality Improvement Program; DVT = deep venous thrombosis; HIPAA = Health Insurance Portability and Accountability Act; RBCs = red blood cells; RVU = relative value unit; SSI = surgical site infection; neurosurgery; postoperative complications; resident involvement