Shunts: Is Surgical Education Safe?

Aim: More data regarding complications in neurosurgery residents’ cases is needed to assess patients’ safety during hands-on surgical education.

Methods: Retrospective 2-center study comparing consecutive patients undergoing shunt implantation by a supervised neurosurgery resident (teaching cases) versus a board-certified faculty neurosurgeon (BCFN; nonteaching cases). Primary endpoint was surgical revision after shunting. Uni- and multivariate Cox’s 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.

Results: A total of n = 320 shunts (n = 180 [56.3%] teaching and n = 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 [HR] 0.96, 95% confidence interval [CI] 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 (HR 0.94, 95% CI 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.

Conclusions: The current study results in addition to the literature on neurosurgery resident training supports the safety of supervised early surgical education for shunt surgery.