Article
Can aneurysm surgery be learned without additional morbidity and mortality?
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Authors
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Veit Rohde
- Department of Neurosurgery, Georg-August-University Göttingen, Germany; Department of Neurosurgery, Technical University Aachen, Germany
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Dorothee Wachter
- Department of Neurosurgery, Georg-August-University Göttingen, Germany
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Joachim Michael Gilsbach
- Department of Neurosurgery, Technical University Aachen, Germany
| Published: | September 16, 2010 |
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Outline
Text
Objective: Aneurysm clipping is a challenging operation. To obtain optimal results, experience is required for thorough understanding of the angioarchitecture of aneurysm and parent vessels, adequate handling of unforeseen intraoperative situations such as premature aneurysm rupture, and focused surgical steps to avoid lengthy operations with the risk of brain swelling. This raises the question, if aneurysm surgery can be learnt without putting the patients at a higher risk for surgery-associated morbidity and mortality.
Methods: Within 15 years, 741 patients underwent clipping of 606 single and 135 multiple aneurysms. The percentage of ruptured aneurysms was 87%. The operations were performed by 3 neurosurgeons experienced in aneurysm surgery (case load per year 14, 16, 24) and by 3 neurosurgeons in training (case load per year 14, 18, 20). Mortality and morbidity (new persisting incapacitating neurological deficit) rates for each of the 6 neurosurgeons were registered. Assuming that the more difficult large to giant and posterior circulation aneurysms had been operated by the experienced neurosurgeons, adjusted mortality rates were additionally calculated.
Results: The overall surgery-associated mortality rate was 2.3% (17/741 patients). The operative mortality rates of the experienced neurosurgeons were 3.9, 4.2 and 2.2% and that of the trainees 1.2, 0, and 1.9%. After adjustment, the mortality rates of the experienced neurosurgeons drop to 1.4, 2.2 and 3% and are as high as those of the trainees. The overall surgery-associated morbidity rate was 4%. The morbidity rates of the experienced neurosurgeons were 3.5, 6.5 and 7.5% and that of the trainees 1.8, 9.5 and 1.3%.
Conclusions: Learning aneurysm surgery is not accompanied by an increase of the morbidity and mortality rates. A certain case load which qualifies for aneurysm surgery cannot be given.
