Cranioplasty: Is Surgical Education Safe?

Area of Science:

• Neurosurgery
• Surgical Training
• Patient Safety

Background:

• Residency training safety in neurosurgery is increasingly scrutinized.
• Cranioplasty (CP) is a standard neurosurgical procedure.
• This study evaluates safety aspects of resident-performed CP.

Purpose of the Study:

• To compare patient safety and outcomes for cranioplasty performed by neurosurgery residents versus attending surgeons.
• To assess complication rates and severity in teaching versus non-teaching cases.
• To evaluate the impact of resident involvement on patient outcomes.

Main Methods:

• Retrospective, 2-center study comparing teaching (resident-supervised) and non-teaching (faculty-performed) cranioplasty cases.
• Primary endpoint: postoperative complications.
• Secondary endpoints: complication severity, surgical site infections requiring implant removal, and modified Rankin Scale scores.

Main Results:

• 240 cranioplasties analyzed (137 teaching, 103 non-teaching).
• No significant difference in postoperative complication rates (OR 0.77, P=0.385) or severity between groups.
• Similar rates of surgical site infections requiring implant removal (OR 1.66, P=0.261) and functional outcomes (mRS improvement, OR 1.11, P=0.719).

Conclusions:

• Supervised neurosurgery residents can safely perform cranioplasty.
• Resident-performed cranioplasty does not increase complication rates or compromise patient outcomes.
• Cranioplasty is a suitable procedure for resident training within structured programs.