title: Shunts: Is Surgical Education Safe?
abstract: BACKGROUND
  More data regarding complications in neurosurgery residents' cases are needed to assess patients' safety during hands-on surgical education.
  
  
  METHODS
  A retrospective 2-center study was performed comparing consecutive patients undergoing shunt implantation by a supervised neurosurgery resident (teaching cases) versus a board-certified faculty neurosurgeon (nonteaching cases). The primary end point was surgical revision after shunting. Univariate and multivariate Cox proportional hazard models (Breslow method for ties) with time censored at 2 years were used to examine time-to-event data. Operation time, length of hospitalization, intracranial hemorrhage, and misplacement of the shunt catheter were other outcome measures to be compared between the groups.
  
  
  RESULTS
  A total of 320 shunts (180 [56.3%] teaching and 140 [43.7%] nonteaching cases) with a mean follow-up of 563 ± 771 days (standard deviation) were analyzed. Revision rates for the entire cohort were 9.3% at 90 days, 13.3% at 6 months, 18.4% at 1 year, and 26.5% at 2 years. In univariate analysis, teaching cases were 96% as likely as nonteaching cases to be surgically revised (hazard ratio, 0.96; 95% confidence interval, 0.54-1.70; P = 0.877). In multivariate analysis adjusted for indication and shunt type, teaching cases were 94% as likely as nonteaching cases to undergo surgical revision (hazard ratio, 0.94; 95% confidence interval, 0.53-1.69; P = 0.847). There were no group differences in operation time, length of hospitalization, intracranial hemorrhage, and rates of shunt misplacement.
  
  
  CONCLUSIONS
  The results of the current study in addition to the literature on neurosurgery resident training support the safety of supervised early surgical education for shunt surgery.
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, Switzerland.
authors.forename: Holger
authors.initials: H
authors.lastname: Joswig
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, Switzerland.
authors.forename: Dario
authors.initials: D
authors.lastname: Jucker
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Switzerland.
authors.forename: Adrien
authors.initials: A
authors.lastname: Lavalley
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Switzerland.
authors.forename: Lima
authors.initials: L
authors.lastname: Sprenger
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Switzerland; Neuro- and Spine Centre, Hirslanden Clinic St. Anna, Lucerne, Switzerland.
authors.forename: Oliver P
authors.initials: OP
authors.lastname: Gautschi
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, Switzerland.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hildebrandt
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Switzerland.
authors.forename: Karl
authors.initials: K
authors.lastname: Schaller
authors.affiliation: Neuro- and Spine Centre, Hirslanden Clinic St. Anna, Lucerne, Switzerland; Department of Neurosurgery, University Hospital Zurich, Switzerland. Electronic address: mnstienen@gmail.com.
authors.forename: Martin N
authors.initials: MN
authors.lastname: Stienen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D006470:Hemorrhage / Q000601:surgery; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric; D017287:Ventriculoperitoneal Shunt / Q000193:education* / Q000379:methods*
chemical_list: D002097:C-Reactive Protein
keywords: Complication; Hydrocephalus; Outcome; Resident training; Risk; Safety; Shunt; Surgical education