Joswig Holger, Jucker Dario, Lavalley Adrien, Sprenger Lima, Gautschi Oliver P, Hildebrandt Gerhard, Schaller Karl, Stienen Martin N
Department of Neurosurgery, Cantonal Hospital St. Gallen, Switzerland.
Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Switzerland.
World Neurosurg. 2017 Jun;102:117-122. doi: 10.1016/j.wneu.2017.02.128. Epub 2017 Mar 9.
More data regarding complications in neurosurgery residents' cases are needed to assess patients' safety during hands-on surgical education.
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.
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.
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.
需要更多关于神经外科住院医师手术病例并发症的数据，以评估实践手术教育期间患者的安全性。
进行了一项回顾性双中心研究，比较由带教神经外科住院医师进行分流植入手术的连续患者（教学病例）与获得委员会认证的神经外科教员（非教学病例）。主要终点是分流术后的手术翻修。使用单变量和多变量Cox比例风险模型（Breslow方法处理 ties），将时间截尾设定为2年，来检查事件发生时间数据。手术时间、住院时间、颅内出血和分流导管误置是两组之间要比较的其他结局指标。
共分析了320例分流手术（180例[56.3%]教学病例和140例[43.7%]非教学病例），平均随访时间为563±771天（标准差）。整个队列的翻修率在90天时为9.3%，6个月时为13.3%，1年时为18.4%，2年时为26.5%。在单变量分析中，教学病例进行手术翻修的可能性是非教学病例的96%（风险比，0.96；95%置信区间，0.54 - 1.70；P = 0.877）。在针对适应证和分流类型进行调整的多变量分析中，教学病例进行手术翻修的可能性是非教学病例的94%（风险比，0.94；95%置信区间，0.53 - 1.69；P = 0.847）。手术时间、住院时间、颅内出血和分流导管误置率在两组之间没有差异。
除了关于神经外科住院医师培训的文献外，本研究结果支持分流手术早期带教手术教育的安全性。
