Publikation

Shunts: Is Surgical Education Safe?

Wissenschaftlicher Artikel/Review - 09.03.2017

Bereiche
PubMed
DOI

Zitation
Joswig H, Jucker D, Lavalley A, Sprenger L, Gautschi O, Hildebrandt G, Schaller K, Stienen M. Shunts: Is Surgical Education Safe?. World Neurosurg 2017; 102:117-122.
Art
Wissenschaftlicher Artikel/Review (Englisch)
Zeitschrift
World Neurosurg 2017; 102
Veröffentlichungsdatum
09.03.2017
eISSN (Online)
1878-8769
Seiten
117-122
Kurzbeschreibung/Zielsetzung

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.