Maldaner Nicolai, Sosnova Marketa, Sarnthein Johannes, Bozinov Oliver, Regli Luca, Stienen Martin N
Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
Acta Neurochir (Wien). 2018 May;160(5):901-911. doi: 10.1007/s00701-017-3458-8. Epub 2018 Jan 8.
There is a paucity of data concerning the safety and efficacy of surgical education for neurosurgical residents in the evacuation of chronic subdural hematomas (cSDH) by burr hole trepanation.
This is a retrospective analysis of prospectively collected data on consecutive patients receiving burr hole trepanation for uni- or bilateral cSDH. Patients operated by a supervised neurosurgery resident (teaching cases) were compared to patients operated by a board-certified faculty neurosurgeon (BCFN; non-teaching cases). The primary endpoint was surgical revision for any reason until the last follow-up. The secondary endpoint was occurrence of any complication until the last follow-up. Clinical status, type of complications, mortality, length of surgery (LOS), and hospitalization (LOH) were tertiary endpoints.
A total of n = 253 cases were analyzed, of which n = 217 (85.8%) were teaching and n = 36 (14.2%) non-teaching cases. The study groups were balanced in terms of age, sex, surgical risk (ASA score), and preoperative status (Karnofsky Performance Scale (KPS), modified Rankin Scale (mRS), National Institute of Health Stroke Scale (NIHSS)). The cohort was followed for a mean of 242 days (standard deviation 302). In multivariate analysis, teaching cases were as likely as non-teaching cases to require revision surgery (OR 0.65, 95% CI 0.27-1.59; p = 0.348) as well as to experience any complication until the last follow-up (OR 0.79, 95% CI 0.37-1.67; p = 0.532). Mean LOS was about 10 min longer in teaching cases (53.0 ± 26.1 min vs. 43.5 ± 17.8 min; p = 0.036), but LOH was similar. There were no group differences in clinical status, mortality and type of complication at discharge, and the last follow-up.
Burr hole trepanation for cSDH can be safely performed by supervised neurosurgical residents enrolled in a structured training program, without increasing the risk for revision surgery, perioperative complications, or worse outcome.
关于神经外科住院医师在慢性硬膜下血肿（cSDH）钻孔引流手术教育方面的安全性和有效性的数据匮乏。
这是一项对前瞻性收集的连续接受单侧或双侧cSDH钻孔引流手术患者数据的回顾性分析。将由接受监督的神经外科住院医师进行手术的患者（教学病例）与由获得委员会认证的神经外科教员（BCFN；非教学病例）进行手术的患者进行比较。主要终点是直至最后一次随访时因任何原因进行的手术翻修。次要终点是直至最后一次随访时发生的任何并发症。临床状况、并发症类型、死亡率、手术时长（LOS）和住院时长（LOH）是三级终点。
共分析了n = 253例病例，其中n = 217例（85.8%）为教学病例，n = 36例（14.2%）为非教学病例。研究组在年龄、性别、手术风险（ASA评分）和术前状况（卡诺夫斯基功能状态量表（KPS）、改良Rankin量表（mRS）、美国国立卫生研究院卒中量表（NIHSS））方面均衡。该队列平均随访242天（标准差302）。在多变量分析中，教学病例与非教学病例一样，直至最后一次随访时需要进行翻修手术的可能性（OR 0.65，95% CI 0.27 - 1.59；p = 0.348）以及发生任何并发症的可能性（OR 0.79，95% CI 0.37 - 1.67；p = 0.532）相同。教学病例的平均LOS长约10分钟（53.0 ± 26.1分钟对43.5 ± 17.8分钟；p = 0.036），但LOH相似。出院时以及最后一次随访时，两组在临床状况、死亡率和并发症类型方面无差异。
对于cSDH的钻孔引流手术，参加结构化培训项目且接受监督的神经外科住院医师可以安全地进行，而不会增加手术翻修、围手术期并发症或更差预后的风险。
