1393. Impact of Multiple Residents Participating in Neurosurgical Case Length – A Single Institutional Analysis

Authors: William Coggins; Anthony Nguyen, BA; Rishabh Jain, BS; Daniel Branch, MD; Randall Allison, MD; Ken Maynard, MD; Rishi Lall, MD (Galveston, TX)

Introduction: Neurosurgical training is expensive: USA neurosurgical societies estimated in 2012 that a seven-year residency costs $1,200,000. Furthermore, resident involvement versus no resident involvement in neurosurgical cases has been associated with increased procedure time, complication rates, and infections. However, the impact of multiple residents on operating room utilization has not been analyzed. Here, we describe the association between the number of scrubbed-in residents and procedural length. Methods: We retrospectively analyzed patients who underwent a neurosurgical operation by one of our three faculty neurosurgeons from 2013-2016, recording the specific surgery performed, faculty neurosurgeon, number of residents scrubbed, experience level of the most junior resident, and procedure length. Multivariable linear regression was performed to assess variables’ associations with operative length. We excluded multidisciplinary surgeries, cases without residents, and procedures performed <10 times during the study period. Results: A total of 432 patients underwent cranial operations, and 388 underwent spinal surgeries. The peripheral nerve sample size was insufficient for analysis. Each additional resident was associated with a 14-minute longer case in cranial operations, even when controlling for specific procedure such as hematoma evacuation versus skull base tumor resection (p=0.006), with no significant association in spinal surgeries (p=0.865). In cranial cases, when the most inexperienced resident was a senior (PGY5 or higher), procedure time was 17 minutes longer (p=0.04). In spinal surgery, each additional level operated upon was associated with a 26-minute longer procedure time (p<0.001). Conclusion: Additional resident participation was associated with increased procedure time in cranial but not spine cases. Prospective studies of resident impact on procedure length could elucidate explanatory mechanisms of resident impact on cranial cases in order to optimize the educational experience of residents without incurring increased cost or compromising patient outcomes due to increased operative length.