title: Microscopic lumbar spinal stenosis decompression: is surgical education safe?
abstract: BACKGROUND
  Acquiring operative skills in the course of a structured neurosurgery residency training program is vital to safely operating on patients autonomously upon board certification. We tested the hypothesis that the complication rates and outcome of microscopic lumbar spinal stenosis (LSS) decompression done by supervised residents are not inferior to those of board-certified faculty neurosurgeons (BCFNs).
  
  
  METHODS
  Retrospective single-center study performed at a Swiss teaching hospital comparing consecutive patients undergoing surgery for LSS by a supervised neurosurgery resident (teaching cases) to a consecutive series of patients operated on by a BCFN (non-teaching cases). The primary endpoint was occurrence of complications during surgery. Secondary endpoints were patients' clinical outcomes 4 weeks after surgery, categorized into a binary responder and non-responder variable, occurrence of postoperative complications, need for re-do surgery, and clinical outcome until the last follow-up (FU).
  
  
  RESULTS
  In a total of n = 471 operations, n = 194 (41.2 %) were teaching cases and n = 277 (58.8 %) non-teaching cases. A longer operation time (single-level procedures: mean 100.0 vs. 83.2 min, p < 0.001) was recorded for teaching cases, while estimated blood loss was equal (single-level procedures: mean 109.9 vs. 117.0 ml, p = 0.409). In multivariate analysis, supervised residents were as likely as BCFNs to have an intraoperative complication (OR 0.92, 95 % CI 0.41-2.04, p = 0.835). They were as likely as BCFNs to achieve a favorable 4-week response to surgery (OR 1.82, 95 % CI 0.79-4.15, p = 0.155). Until final FU, the likelihood for patients in the teaching group to suffer from postoperative complications (OR 1.07, 95 % CI 0.46-2.49, p = 0.864) or require re-do surgery (OR 0.68, 95 % CI 0.31-1.52, p = 0.358) was similar to that of the non-teaching group.
  
  
  CONCLUSIONS
  Complication rates and short- and mid-term outcomes following LSS decompression were comparable for patients operated on by supervised neurosurgery residents and senior neurosurgeons. Our data thus indicate that a structured neurosurgical hands-on training including LSS decompression is safe for patients.
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Holger
authors.initials: H
authors.lastname: Joswig
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Carolin
authors.initials: C
authors.lastname: Hock
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hildebrandt
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Geneva, Switzerland.
authors.forename: Karl
authors.initials: K
authors.lastname: Schaller
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Geneva, Switzerland. mnstienen@gmail.com.
authors.forename: Martin N
authors.initials: MN
authors.lastname: Stienen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000009:adverse effects / Q000193:education / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000592:standards; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000193:education* / Q000592:standards; D011183:Postoperative Complications / Q000453:epidemiology; D013130:Spinal Stenosis / Q000601:surgery*
keywords: Complication; Decompression surgery; Lumbar spinal stenosis; Outcome; Surgical education; Training