Burr hole trepanation for chronic subdural hematomas: is surgical education safe?
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.
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.
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.
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.
KeywordsBurr hole trepanation Chronic subdural hematoma Surgical education Outcome Safety Training Complications
American Society of Anesthesiology grading scale
Board-certified faculty neurosurgeon
Chronic subdural hematoma
Length of hospitalization
Length of surgery
Karnofsky Performance Scale
Modified Rankin scale
National Institute of Health Stroke Scale
The authors thank all resident and staff physicians of the department, who prospectively collected and verified the data that is the basis of the current analysis.
No funding was received for this research.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The local ethics committee (Kantonale Ethikkommission KEK-ZH 2012–0244) approved the prospective data collection in the patient registry. The study was registered at clinicaltrials.gov (NCT01628406) and follows the STROBE recommendation for observational studies.
Informed consent was obtained from all individual participants included in the study.
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