title: Cranioplasty: Is Surgical Education Safe?
abstract: BACKGROUND
  Patient safety aspects and the residents' role in spine surgery within a structured training program have recently been investigated. The current work deals with residency training safety aspects for cranioplasty (CP), a standard neurosurgical cranial procedure.
  
  
  METHODS
  Retrospective 2-center study comparing consecutive patients undergoing CP by a supervised neurosurgery resident (teaching cases) with a consecutive series of patients operated on by a board-certified faculty neurosurgeon (nonteaching cases). The primary end point was occurrence of a postoperative complication. Secondary end points were severity (Ibañez degree) of postoperative complications, surgical site infections requiring CP removal and patients' clinical outcome measured with the modified Rankin Scale.
  
  
  RESULTS
  A total of 240 CPs (137 teaching [57.1%] and 103 nonteaching [42.9%] cases) were analyzed. The mean teaching case operation time was longer (129.2 vs. 115.8 minutes; P < 0.001), and there was no difference in the estimated blood loss (mean 243.3 vs. 223.1 mL; P = 0.444). Supervised residents were as likely as board-certified faculty neurosurgeons to have a postoperative complication (odds ratio [OR], 0.77; 95% confidence interval [CI], 0.42-1.39; P = 0.385) and the severity was comparable (Pearson χ(2) = 7.62; P = 0.106). Teaching cases were as likely as nonteaching cases to experience a surgical site infection requiring CP removal (OR, 1.66; 95% CI, 0.69-4.04; P = 0.261). Also, the likelihood for postoperative improvement on the modified Rankin Scale was similar for patients in both groups (OR, 1.11; 95% CI, 0.62-2.00; P = 0.719).
  
  
  CONCLUSIONS
  A relatively simple cranial procedure, such as CP, can be safely performed by a supervised neurosurgery resident without increasing complications or compromising patients' outcomes.
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 and Faculty of Medicine, University Hospital Geneva, Geneva, Switzerland.
authors.forename: Oliver P
authors.initials: OP
authors.lastname: Gautschi
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Geneva, Switzerland.
authors.forename: Amir
authors.initials: A
authors.lastname: El Rahal
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Geneva, Switzerland.
authors.forename: Lukas
authors.initials: L
authors.lastname: Sveikata
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Geneva, Switzerland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bartoli
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. Electronic address: mnstienen@gmail.com.
authors.forename: Martin N
authors.initials: MN
authors.lastname: Stienen
mesh_terms: D000328:Adult; D003399:Craniotomy / Q000592:standards*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000193:education*; D011183:Postoperative Complications; D012189:Retrospective Studies
keywords: Complication; Cranioplasty; Functional Outcome; Resident Training; Risk; Safety; Surgical Education