Surgical Resident Education in Noninstrumented Lumbar Spine Surgery: A Prospective Observational Study with a 4.5-Year Follow-Up

Martin N Stienen; Nicolas R Smoll; Enrico Tessitore; Karl Schaller; Gerhard Hildebrandt; Oliver P Gautschi

doi:10.1016/j.wneu.2015.07.030

Surgical Resident Education in Noninstrumented Lumbar Spine Surgery: A Prospective Observational Study with a 4.5-Year Follow-Up

World Neurosurg. 2015 Dec;84(6):1589-97. doi: 10.1016/j.wneu.2015.07.030. Epub 2015 Jul 23.

Authors

Martin N Stienen¹, Nicolas R Smoll², Enrico Tessitore³, Karl Schaller³, Gerhard Hildebrandt⁴, Oliver P Gautschi³

Affiliations

¹ Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Neurosurgery and Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland. Electronic address: mnstienen@gmail.com.
² School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
³ Department of Neurosurgery and Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland.
⁴ Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland.

PMID: 26211851
DOI: 10.1016/j.wneu.2015.07.030

Abstract

Objective: To review the outcomes of noninstrumented lumbar spine surgery performed by trainees as primary operators versus the outcomes of surgery performed by board-certified faculty neurosurgeons.

Methods: This prospective observational study involved patients undergoing noninstrumented surgery for lumbar disc herniation or lumbar spinal stenosis with a 4.5-year follow-up. Teaching cases (patients were operated on by neurosurgical residents in training) and nonteaching cases (patients were operated on by board-certified faculty neurosurgeons) were reviewed. Back and leg pain on a visual analog scale, functional disability using the Roland Morris Disability Questionnaire and Oswestry Disability Index, and health-related quality of life (HRQOL) using the 12-Item Short Form Survey and EuroQol 5D were assessed, and reoperations since the index surgery were recorded.

Results: Questionnaires were returned by 30 patients operated on by residents and 74 patients operated on by board-certified faculty neurosurgeons. On the 12-Item Short Form Survey physical component scale metric, teaching cases were 70% as likely as nonteaching cases (odds ratio = 0.70, 95% confidence interval = 0.25-1.98, P = 0.585) to achieve a favorable HRQOL response to surgery. Visual analog scale measures of back and leg pain were similar for teaching and nonteaching cases. The same was true for functional disability as measured by the Roland Morris Disability Questionnaire and Oswestry Disability Index and for HRQOL measured by the EuroQol 5D. The reoperation rate 4.5 years after the index surgery was also similar for both groups (∼ 10% for both groups).

Conclusions: The global outcome, as measured by HRQOL response after a mean follow-up of 4.5 years, was similar for teaching and nonteaching cases. Patients from both groups scored virtually equal results on various pain, functional, and HRQOL metrics, and the reoperation rate was similar.

Keywords: Functional outcome; Health-related quality of life; Long-term follow-up; Lumbar spine surgery; Surgical resident education.

Publication types

Observational Study

MeSH terms

Adult
Disability Evaluation
Female
Humans
Internship and Residency*
Intervertebral Disc Displacement / complications
Intervertebral Disc Displacement / physiopathology
Intervertebral Disc Displacement / surgery*
Leg
Low Back Pain / etiology
Male
Neurosurgery / education*
Neurosurgical Procedures / methods*
Orthopedic Procedures / methods
Orthopedics / education
Pain / etiology
Prospective Studies
Quality of Life
Spinal Stenosis / complications
Spinal Stenosis / physiopathology
Spinal Stenosis / surgery*
Visual Analog Scale