Resident participation is not associated with postoperative adverse events, reoperation, or prolonged length of stay following craniotomy for brain tumor resection

Prior studies exploring the impact of resident involvement on complication and mortality rates in neurosurgery have evaluated heterogeneous cohorts. Since brain tumor resection is characterized by significant operative complexity, variety, and morbidity, intraoperative resident involvement has the potential to impact patient outcomes. The purpose of this study was thus to explore the relationship between resident involvement and patient outcomes following craniotomy for brain tumor resection. Data for adult patients undergoing craniotomy for brain tumor resection were extracted from the 2008-2014 National Surgical Quality Improvement Program database. Resident involvement was determined for all included cases, and evaluated for association with patient outcomes via multivariable, binary logistic regression modeling while controlling for perioperative variables. Outcomes included death, prolonged length of stay (LOS), readmission, reoperation, and pertinent complications. A total of 3587 cases met the inclusion criteria, 2926 (81.6%) of which were supratentorial tumors and 661 (18.4%) were infratentorial lesions. Residents were involved in 63.6% of cases. Resident participation was associated with a reduced incidence of prolonged LOS (OR 0.68, 95% CI 0.54-0.86, P = 0.001) and urinary tract infection (UTI) (OR 0.63, 95% CI 0.40-0.98, P = 0.038), and approached significance for reduced mortality rate (OR 0.63, 95% CI 0.39-1.03, P = 0.064). These associations were observed for patients with supratentorial tumors but not for those with infratentorial lesions. Resident involvement was not significantly associated with any of the other outcome metrics. Resident involvement was not a risk factor for any adverse events, and was associated with reduced incidence of prolonged LOS and UTI. The observed relationships may be impacted by institution-level factors.