Safety of resident training in the microsurgical resection of intracranial tumors: Data from a prospective registry of complications and outcome

Nature: Scientific Reports. Published online: January 30th, 2019. DOI: 10.1038/s41598-018-37533-3.

Flavio Vasella, Julia Velz, Marian C. Neidert, Stephanie Henzi, Johannes Sarnthein, Niklaus Krayenbühl, Oliver Bozinov, Luca Regli & Martin N. Stienen.

The aim of the present study was to assess the safety of microsurgical resection of intracranial tumors performed by supervised neurosurgical residents. We analyzed prospectively collected data from
our institutional patient registry and dichotomized between procedures performed by supervised
neurosurgery residents (defined as teaching procedures) or board-certified faculty neurosurgeons
(defined as non-teaching procedures). The primary endpoint was morbidity at discharge, defined as a
postoperative decrease of ≥10 points on the Karnofsky Performance Scale (KPS). Secondary endpoints
included 3-month (M3) morbidity, mortality, the in-hospital complication rate, and complication
type and severity. Of 1,446 consecutive procedures, 221 (15.3%) were teaching procedures. Patients
in the teaching group were as likely as patients in the non-teaching group to experience discharge
morbidity in both uni- (OR 0.85, 95%CI 0.60–1.22, p = 0.391) and multivariate analysis (adjusted OR
1.08, 95%CI 0.74–1.58, p = 0.680). The results were consistent at time of the M3 follow-up and in
subgroup analyses. In-hospital mortality was equally low (0.24 vs. 0%, p = 0.461) and the likelihood
(p = 0.499), type (p = 0.581) and severity of complications (p = 0.373) were similar. These results suggest that microsurgical resection of carefully selected intracranial tumors can be performed safely by supervised neurosurgical residents without increasing the risk of morbidity, mortality or perioperative complications. Appropriate allocation of operations according to case complexity and the resident’s experience level, however, appears essential.