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Neurosurgical procedures performed during residency in Europe—preliminary numbers and time trends

  • Original Article - Neurosurgery Training
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Differences in the postgraduate training programs of neurosurgical residents are suspected throughout Europe. The influence of working hour restrictions by the European Working Time Directive (WTD) 2003/88/EC on the number of surgical procedures remains unclear. We designed a survey to collect information on the number of surgical procedures, performed by European neurosurgical trainees during residency. This article reports preliminary data.

Methods

An electronic survey was distributed among the European Association of Neurosurgical Societies (EANS) member countries by national delegates of the training committee, as well as by members of the Young Neurosurgeons’ committee. The EANS mailing list of individual members was also used for distribution. All responses received between 04/2018 and 12/2018 were considered.

Results

From n = 180 responses received, 42 were omitted as responders were still in residency and for 58 relevant information was missing. The final sample was n = 80, with a mean responder’s age of 43.0 years (SD 8.6) and 88.8% being male. Responses came from 16 European countries; board certification was received between the years of 1976–2018. The numbers of surgical procedures performed independently were 511 (mean, 95% confidence interval (CI) 413–610), supervised were 514 (95%CI 360–668) and assisted were 752 (95%CI 485–1019) throughout residency. More detailed numbers for specific procedure types are reported in the article. Independently performed cranial procedures outnumbered spinal procedures (p < 0.006), and adult procedures outnumbered pediatric procedures (p < 0.001). There was a strong decrease in caseload between 1976 and 2018, with trainees performing on average 65 cases less throughout residency for each calendar year increase in board certification (95% CI − 116 to − 15, p = 0.012). Trainees graduating residency before introduction of the European WTD 2003/88/EC participated in more procedures than those graduating afterwards (mean 2797 vs. 1418, p = 0.005).

Conclusions

The preliminary analysis of the first 80 responses now provides a first reference frame for caseload that can be used by current and future European residents to critically compare their own operative numbers to. There was a strong decline in surgical cases over time, and trainees graduating after introduction of the European WTD 2003/88/EC had less surgical exposure. The survey remains open, and we invite further European neurosurgeons to provide their data in order to get even more robust estimates.

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Abbreviations

CI:

confidence interval

EANS:

European Association of Neurosurgical Societies

h:

hours

JRAAC:

Joint Residency Advisory and Accreditation Committee

OR:

operation room

SD:

standard deviation

UK:

United Kingdom

US:

United States (of America)

VP:

ventriculo-peritoneal

WTD:

working time directive

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Acknowledgements

We want to acknowledge the substantial support that we have received from the EANS office with regard to generating, approving and distributing the survey, in particular Amy Pinchbeck-Smith, Petra Koubova, Liz Derow and Francesco Sala. We thank the EANS Young Neurosurgeons & EANS Training Committee members for reviewing and revising the questionnaire, in particular those who also distributed the survey among their national societies. We thank Hans Clusmann, Pierre-Hugues Roche, Yerbol Makhambetov, Marcel Ivanov and Laszlo Novak for initiating its distribution among the Neurosurgical Societies in Germany, France, Kazakhstan, Great Britain and Hungary, respectively.

Survey

The survey continues to be accessible under the following link: https://www.surveymonkey.com/r/RJMSLCG. We would like to invite neurosurgeons, who have finished their neurosurgical training in a European country (for the most part), to provide their surgical case numbers, using the link provided. Please note that confidentiality of individual responses is provided. Responders may provide their data anonymously but can choose to indicate their name for indexing purpose as contributor on publications that use survey data.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland

    Martin N. Stienen & Luca Regli

  2. Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland

    Martin N. Stienen & Luca Regli

  3. Department of Clinical Neuroscience and Medicine, Karolinska Institutet, Stockholm, Sweden

    Jiri Bartek Jr

  4. Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark

    Jiri Bartek Jr

  5. Department of Neurosurgery, Charité University Hospital, Berlin, Germany

    Marcus A. Czabanka

  6. Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria

    Christian F. Freyschlag

  7. Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK

    Angelos Kolias

  8. Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany

    Sandro M. Krieg

  9. HAGA Teaching Hospital and Medical Center Haaglanden, The Hague & Leiden University Medical Center, Leiden, Netherlands

    Wouter Moojen

  10. Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany

    Mirjam Renovanz & Sasan D. Adib

  11. Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain

    Nicolas Sampron

  12. Department of Neurosurgery, RWTH Aachen University, Aachen, Germany

    Gerrit A. Schubert

  13. Department of Neurosurgery, Western General Hospital, Edinburgh, UK

    Andreas K. Demetriades

  14. Department of Neurosurgery, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany

    Florian Ringel

  15. Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland

    Karl Schaller & Torstein R. Meling

Authors
  1. Martin N. Stienen
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  8. Mirjam Renovanz
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Consortia

for the EANS Young Neurosurgeons and EANS Training Committee

  • Sasan D. Adib
  • , Amro Al-Habib
  • , Rafid Al-Mahfoudh
  • , Ridvan Alimehmeti
  • , Aymeric Amelot
  • , Lisa Arvidsson
  • , Nurali Ashirov
  • , Toomas Asser
  • , Kaspar Auslands
  • , Cecilia I. A. Avellan
  • , Jiri Bartek Jr
  • , Jacques Beaurain
  • , Luka Berilazic
  • , Roman Bosnjak
  • , Pierre Bourdillon
  • , Oliver Bozinov
  • , Anna Martina Brunner
  • , Bilginer Burcak
  • , Alexandre Carpentier
  • , Antonio Cerejo
  • , Hans Clusmann
  • , Dominik Cordier
  • , Marcus Czebanka
  • , Suparna Das
  • , Andreas Demetriades
  • , Sandra F. Dias
  • , Francesco DiMeco
  • , Djula Djilvesi
  • , Johnny Duerinck
  • , Chloé Dumot
  • , Pierre-Jacques Finiels
  • , Nikolaos Foroglou
  • , Christian F. Freyschlag
  • , Arnab Ghosh
  • , Dimitrios Giakoumettis
  • , Nathalie Gilis
  • , Jagos Golubovic
  • , Stefan J. Grau
  • , Nils Hecht
  • , Markus Holling
  • , Bogdan Iliescu
  • , Marcel Ivanov
  • , Timothee Jacquesson
  • , Dariusz Jakolski
  • , Ibrahim Jalloh
  • , Assylbek Kaliyev
  • , Almuth F. Kessler
  • , Jean-Charles Kleiber
  • , Angelos Kolias
  • , Nikolay Konovalov
  • , Karl F. Kothbauer
  • , Vojin Kovacevic
  • , Nenad Krajcinovic
  • , Sandro M. Krieg
  • , Aki Laakso
  • , Christophe Lapras
  • , Aaron Lawson McLean
  • , Caroline Le Guerinel
  • , Milan Lepic
  • , Dominique Liguoro
  • , Johan Ljungqvist
  • , William B. Lo
  • , Ivan Macuga
  • , Martin Majovsky
  • , Yerbol Makhambetov
  • , Francesco Marchi
  • , Torstein R. Meling
  • , Anthony Melot
  • , Antonio Meola
  • , Patrick Mertens
  • , Stephen Metcalfe
  • , Svein Harald Moerkve
  • , Wouter Moojen
  • , Arsim Morina
  • , Mohammad Jawad Naushahi
  • , Laszio Novak
  • , Aitimbetov Nurzhan
  • , Ibrahim Omerhodzic
  • , Johan Pallud
  • , Vakis Papanastassiou
  • , Vladimir Papic
  • , Michael Payer
  • , Jenny Pettersson Segerlind
  • , Jussi P. Posti
  • , Francois Proust
  • , Lukas Rasulic
  • , Luca Regli
  • , Michael Reinert
  • , Mirjam Renovanz
  • , Florian Ringel
  • , Jaako Rinne
  • , Pierre-Hugues Roche
  • , Saulius Rocka
  • , Roman Rotermund
  • , Scott A. Rutherford
  • , Tönu Rätsep
  • , Ilkka M. Saarenpää
  • , Marko Samardzic
  • , Nicolas Sampron
  • , Ulrika Sandvik
  • , Michel Schneider
  • , Gerrit Schubert
  • , Saurabh Sinha
  • , Jane Skjoeth-Rasmussen
  • , Volodymyr Smolanka
  • , Martin Smrcka
  • , Ole Solheim
  • , Sergey Spektor
  • , Martin N. Stienen
  • , Mario Teo
  • , Claudius Thomé
  • , Simon Thomson
  • , Magnus Tisell
  • , Cristina P. Torres Diaz
  • , Dirk Van Roost
  • , Henk van Santbrink
  • , Nicolay Velinov
  • , Aleksic Vuk
  • , Miroslav Vukic
  • , James Walkden
  •  & Christopher Wendel

Corresponding author

Correspondence to Martin N. Stienen.

Ethics declarations

Conflicts of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

For this type of study, formal consent is not required.

Informed consent

Survey participation was voluntary. No patient data was collected.

Additional information

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This article is part of the Topical Collection on Neurosurgery Training

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APPENDIX

APPENDIX

Collaborators of the “EANS YNC and TC” (listed in alphabetical order):

  • Sasan D. Adib

  • Amro Al-Habib

  • Rafid Al-Mahfoudh

  • Ridvan Alimehmeti

  • Aymeric Amelot

  • Lisa Arvidsson

  • Nurali Ashirov

  • Toomas Asser

  • Kaspar Auslands

  • Cecilia I. A. Avellan

  • Jiri Bartek Jr.

  • Jacques Beaurain

  • Luka Berilazic

  • Roman Bosnjak

  • Pierre Bourdillon

  • Oliver Bozinov

  • Anna Martina Brunner

  • Bilginer Burcak

  • Alexandre Carpentier

  • Antonio Cerejo

  • Hans Clusmann

  • Dominik Cordier

  • Marcus Czabanka

  • Suparna Das

  • Andreas K. Demetriades

  • Sandra F. Dias

  • Francesco DiMeco

  • Djula Djilvesi

  • Johnny Duerinck

  • Chloé Dumot

  • Pierre-Jacques Finiels

  • Nikolaos Foroglou

  • Christian F. Freyschlag

  • Arnab Ghosh

  • Dimitrios Giakoumettis

  • Nathalie Gilis

  • Jagos Golubovic

  • Stefan J. Grau

  • Nils Hecht

  • Markus Holling

  • Bogdan Iliescu

  • Marcel Ivanov

  • Timothee Jacquesson

  • Dariusz Jakolski

  • Ibrahim Jalloh

  • Assylbek Kaliyev

  • Almuth F. Kessler

  • Jean-Charles Kleiber

  • Angelos Kolias

  • Nikolay Konovalov

  • Karl F. Kothbauer

  • Vojin Kovacevic

  • Nenad Krajcinovic

  • Sandro M. Krieg

  • Aki Laakso

  • Christophe Lapras

  • Aaron Lawson McLean

  • Caroline Le Guerinel

  • Milan Lepic

  • Dominique Liguoro

  • Johan Ljungqvist

  • William B. Lo

  • Ivan Macuga

  • Martin Majovsky

  • Yerbol Makhambetov

  • Francesco Marchi

  • Torstein R. Meling

  • Anthony Melot

  • Antonio Meola

  • Patrick Mertens

  • Stephen Metcalfe

  • Svein Harald Moerkve

  • Wouter Moojen

  • Arsim Morina

  • Mohammad Jawad Naushahi

  • Laszio Novak

  • Aitimbetov Nurzhan

  • Ibrahim Omerhodzic

  • Johan Pallud

  • Vakis Papanastassiou

  • Vladimir Papic

  • Michael Payer

  • Jenny Pettersson Segerlind

  • Jussi P. Posti

  • Francois Proust

  • Lukas Rasulic

  • Luca Regli

  • Michael Reinert

  • Mirjam Renovanz

  • Florian Ringel

  • Jaako Rinne

  • Pierre-Hugues Roche

  • Saulius Rocka

  • Roman Rotermund

  • Scott A. Rutherford

  • Tönu Rätsep

  • Ilkka M. Saarenpää

  • Marko Samardzic

  • Nicolas Sampron

  • Ulrika Sandvik

  • Michel Schneider

  • Gerrit A. Schubert

  • Saurabh Sinha

  • Jane Skjoeth-Rasmussen

  • Volodymyr Smolanka

  • Martin Smrcka

  • Ole Solheim

  • Sergey Spektor

  • Martin N. Stienen

  • Mario Teo

  • Claudius Thomé

  • Simon Thomson

  • Magnus Tisell

  • Cristina P. Torres Diaz

  • Dirk Van Roost

  • Henk van Santbrink

  • Nicolay Velinov

  • Aleksic Vuk

  • Miroslav Vukic

  • James Walkden

  • Christopher Wendel

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Stienen, M.N., Bartek, J., Czabanka, M.A. et al. Neurosurgical procedures performed during residency in Europe—preliminary numbers and time trends. Acta Neurochir 161, 843–853 (2019). https://doi.org/10.1007/s00701-019-03888-3

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