Endoscopic Endonasal Pituitary Surgery: Impact of Surgical Education on Operation Length and Patient Morbidity

Abstract

Objectives To determine the difference in operative times and associated complications for cases performed solely by attending-level surgeons versus cases assisted by surgeons-in-training for endoscopic endonasal pituitary surgeries.

Design Retrospective chart review.

Setting Tertiary-care academic medical center.

Participants A total of 228 patients having undergone endoscopic endonasal pituitary surgery from 2005 to 2011.

Main Outcome Measure Duration of surgery comparing attending only (AO) and trainee-assisted (TA) surgeries.

Results Thirty-seven (19%) of 198 cases were identified as AO surgeries, the remaining 161 (81%) were TA. Operative times (minutes) for the AO group were significantly shorter than the TA group (149.1 ± 54.8 vs 219.5 ± 83.7, p < 0.001). The AO group had fewer intraoperative cerebrospinal fluid leaks (30% vs 39%, p = 0.318), decreased estimated blood loss (408 mL vs 523 mL, p = 0.176), fewer postoperative complications (27% vs 37%, p = 0.268), and shorter length of stay (3.5 vs 4.3 days, p = 0.294).

Conclusions This is the first study in otolaryngology or neurosurgery to compare operative times and outcomes for AO versus TA cases at a single academic institution. Operative times were significantly decreased and a trend toward a decrease in patient morbidity was noted for cases performed solely by attendings. The valuation of teaching activities in the operating room is a necessary first step toward optimizing the allocation of resources and funding of surgical education.

Keywords

skull base surgery - pituitary surgery - residency training - surgical education - endoscopic endonasal approach

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