Cranioplasty: Is Surgical Education Safe?

Patient safety aspects and the residents' role in spine surgery within a structured training program have recently been investigated. The current work deals with residency training safety aspects for cranioplasty (CP), a standard neurosurgical cranial procedure.

Retrospective 2-center study comparing consecutive patients undergoing CP by a supervised neurosurgery resident (teaching cases) with a consecutive series of patients operated on by a board-certified faculty neurosurgeon (nonteaching cases). The primary end point was occurrence of a postoperative complication. Secondary end points were severity (Ibañez degree) of postoperative complications, surgical site infections requiring CP removal and patients' clinical outcome measured with the modified Rankin Scale.

A total of 240 CPs (137 teaching [57.1%] and 103 nonteaching [42.9%] cases) were analyzed. The mean teaching case operation time was longer (129.2 vs. 115.8 minutes; P < 0.001), and there was no difference in the estimated blood loss (mean 243.3 vs. 223.1 mL; P = 0.444). Supervised residents were as likely as board-certified faculty neurosurgeons to have a postoperative complication (odds ratio [OR], 0.77; 95% confidence interval [CI], 0.42-1.39; P = 0.385) and the severity was comparable (Pearson χ(2) = 7.62; P = 0.106). Teaching cases were as likely as nonteaching cases to experience a surgical site infection requiring CP removal (OR, 1.66; 95% CI, 0.69-4.04; P = 0.261). Also, the likelihood for postoperative improvement on the modified Rankin Scale was similar for patients in both groups (OR, 1.11; 95% CI, 0.62-2.00; P = 0.719).

A relatively simple cranial procedure, such as CP, can be safely performed by a supervised neurosurgery resident without increasing complications or compromising patients' outcomes.