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Erschienen in: Acta Neurochirurgica 5/2018

08.01.2018 | Original Article - Neurosurgery Training

Burr hole trepanation for chronic subdural hematomas: is surgical education safe?

verfasst von: Nicolai Maldaner, Marketa Sosnova, Johannes Sarnthein, Oliver Bozinov, Luca Regli, Martin N. Stienen

Erschienen in: Acta Neurochirurgica | Ausgabe 5/2018

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Abstract

Background

There is a paucity of data concerning the safety and efficacy of surgical education for neurosurgical residents in the evacuation of chronic subdural hematomas (cSDH) by burr hole trepanation.

Methods

This is a retrospective analysis of prospectively collected data on consecutive patients receiving burr hole trepanation for uni- or bilateral cSDH. Patients operated by a supervised neurosurgery resident (teaching cases) were compared to patients operated by a board-certified faculty neurosurgeon (BCFN; non-teaching cases). The primary endpoint was surgical revision for any reason until the last follow-up. The secondary endpoint was occurrence of any complication until the last follow-up. Clinical status, type of complications, mortality, length of surgery (LOS), and hospitalization (LOH) were tertiary endpoints.

Results

A total of n = 253 cases were analyzed, of which n = 217 (85.8%) were teaching and n = 36 (14.2%) non-teaching cases. The study groups were balanced in terms of age, sex, surgical risk (ASA score), and preoperative status (Karnofsky Performance Scale (KPS), modified Rankin Scale (mRS), National Institute of Health Stroke Scale (NIHSS)). The cohort was followed for a mean of 242 days (standard deviation 302). In multivariate analysis, teaching cases were as likely as non-teaching cases to require revision surgery (OR 0.65, 95% CI 0.27–1.59; p = 0.348) as well as to experience any complication until the last follow-up (OR 0.79, 95% CI 0.37–1.67; p = 0.532). Mean LOS was about 10 min longer in teaching cases (53.0 ± 26.1 min vs. 43.5 ± 17.8 min; p = 0.036), but LOH was similar. There were no group differences in clinical status, mortality and type of complication at discharge, and the last follow-up.

Conclusions

Burr hole trepanation for cSDH can be safely performed by supervised neurosurgical residents enrolled in a structured training program, without increasing the risk for revision surgery, perioperative complications, or worse outcome.
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Metadaten
Titel
Burr hole trepanation for chronic subdural hematomas: is surgical education safe?
verfasst von
Nicolai Maldaner
Marketa Sosnova
Johannes Sarnthein
Oliver Bozinov
Luca Regli
Martin N. Stienen
Publikationsdatum
08.01.2018
Verlag
Springer Vienna
Erschienen in
Acta Neurochirurgica / Ausgabe 5/2018
Print ISSN: 0001-6268
Elektronische ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-017-3458-8

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