Residents Participation In Neurosurgery Did Not 30-Day Outcomes

Judy Huang, M.D. Professor of Neurosurgery Program Director, Neurosurgery Residency Program Fellowship Director, Cerebrovascular Neurosurgery Johns Hopkins Interview with:
Judy Huang, M.D.
Professor of Neurosurgery
Program Director, Neurosurgery Residency Program
Fellowship Director, Cerebrovascular Neurosurgery
Johns Hopkins Hospital

Medical Research: What is the background for this study? What are the main findings?

Dr. Huang: Residents are medical school graduates who are in training programs working alongside and under supervision of more senior physicians, known as attendings. Patients are sometimes wary of having residents assist in their operations, but an analysis of 16,098 brain and spine surgeries performed across the United States finds that resident participation does not raise patient risks for postoperative complications or death.

Medical Research: What should clinicians and patients take away from your report?

Dr. Huang: An analysis of the data from 16,098 patients in American College of Surgeons National Surgical Quality Improvement Program database who had undergone elective or emergent neurosurgical procedures between 2006 and 2012 suggests that contributions of residents had no effect on patients’ risks of postoperative complications or death within 30 days of the surgery.

Overall, 15.8% of all patients had at least one postoperative complication. A complication rate of 20.12% was found in the attending+resident group, while patients with an attending-only surgeon had a statistically significantly lower complication rate at 11.70% (p < 0.001). In the entire study population, 263 patients (1.63%) died within 30 days of surgery. Stratified by operating surgeon status, 162 patients (2.07%) in the attending+resident group died versus 101 (1.22%) in the attending only group (p < 0.001). Regression analyses compared patients who had resident participation to those with only attending surgeons, the referent group. After adjustment for preoperative patient characteristics and comorbidities, multivariate regression analysis demonstrated that patients with resident participation in their surgery had the same odds of 30-day morbidity (OR = 1.05, 95% CI 0.94–1.17) and mortality (OR = 0.92, 95% CI 0.66–1.28) as their attending only counterparts.

Cases with resident participation had higher rates of mortality and morbidity; however, these cases also involved patients with more comorbidities initially. On multivariate analysis, resident participation was not an independent risk factor for postoperative 30-day morbidity or mortality following elective or emergent neurosurgical procedures.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. HuangFurther examination of the effect of resident participation in specific neurosurgical procedures as well as in other surgical subspecialty fields would be of potential interest to patients.


Mohamad Bydon, Nicholas B. Abt, Rafael De la Garza-Ramos, Mohamed Macki, Timothy F. Witham, Ziya L. Gokaslan, Ali Bydon, Judy Huang. Impact of resident participation on morbidity and mortality in neurosurgical procedures: an analysis of 16,098 patients. Journal of Neurosurgery, 2015; 122 (4): 955 DOI: 10.3171/2014.11.JNS14890


Judy Huang, M.D. Professor of Neurosurgery, Program Director, Neurosurgery Residency Program, Fellowship Director, Cerebrovascular Neurosurgery, & Johns Hopkins Hospital (2015). Residents Participation In Neurosurgery Did Not 30-Day Outcomes 

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