Abstract
INTRODUCTION
The impact of the “July effect” on morbidity and mortality rates has been assessed in neurosurgery, but only for heterogeneous cohorts incorporating degenerative spine and diverse cranial operations, including functional cases. The operative resection of brain tumors is characterized by significant surgical complexity, variety, and potentially substantial postoperative morbidity. As such, the purpose of this study was to explore the relationship between resident involvement and patient outcomes following various types of craniotomies for the resection of brain tumors.
METHODS
Data for adult patients undergoing craniotomy for brain tumor resection were extracted from the 2008-2012 National Surgical Quality Improvement database using CPT and ICD-9 coding. Resident involvement was determined for all cases, and evaluated for association with patient outcomes via multivariable, binary logistic regression analysis while controlling for confounding comorbidity and operative variables. Outcomes included death, prolonged length of stay (LOS), readmission, reoperation, neurologic complication, and wound infection.
RESULTS
3,587 cases met inclusion criteria, 2,926 (81.6%) of which involved supratentorial tumors and 661 (18.4%) presenting with infratentorial tumors. Residents participated in 2,281 (63.6%) cases. Resident involvement was associated with a significantly lower risk of prolonged LOS (OR: 0.68, 95%CI: 0.54-0.86, P=0.001). This association was observed for patients undergoing craniotomy for supratentorial tumors (OR: 0.63, 95%CI: 0.49-0.82, P=0.001) but not for infratentorial lesions (OR: 1.05, 95%CI: 0.60-1.84, P=0.86). Resident involvement also approached significance for reduced risk of mortality (OR: 0.63, 95%CI: 0.39-1.03, P=0.06). Resident participation was not an independent predictor of any other outcome metrics for either tumor location.
CONCLUSION
Resident involvement was not a risk factor for any complications or reoperation/readmission, and was associated with reduced risk of prolonged LOS following supratentorial tumor resection. These relationships may be influenced by institutional differences, such as resident participation in the postoperative inpatient care of patients at academic centers.