Introduction: The first academic month often sees a rise in complications due to the inexperience of interns and residents. While previous studies show no impact on outcomes across specialties, this phenomenon remains uncertain in neurosurgery. Our analysis aims to assess the impact of academic year transition with new neurosurgery residents and interns on patient outcomes.
Methods: We searched PubMed, Embase, Web of Science, and Scopus databases for studies comparing neurosurgical outcomes with first-month or first-quartile residents, excluding those not involving neuro-spinal surgeries. We assessed mortality, length of hospital stay (LOS), complications, wound infections, total charges, and reoperations.
Results: We included 16 studies involving 1.4 million patients. There was no significant difference in the first academic month compared to other periods for overall mortality (OR 0.93, 95% CI 0.79-1.08, p=0.33), complications (OR 1.19, 95% CI 0.98-1.45, p=0.08), total charges (MD 530.01, 95% CI -260.94-1320.95, p=0.19), and LOS (SMD 0.00, 95% CI -0.01-0.02, p=0.63). However, there was significantly longer LOS in spinal surgery (SMD 0.03, 95% CI 0.00-0.05, p=0.03) and shorter LOS in cranial surgery (SMD -0.05, 95%CI -0.08,-0.01, p< 0.01), with higher rates of overall reoperations (OR 1.32, 95% CI 1.14-1.53, p< 0.01), reoperations after spinal surgery (OR 1.34, 95% CI 1.03-1.76, p=0.03), and in adults (OR 1.35, 95% CI 1.07-1.72, p=0.01) during first academic month. Additionally, during the first academic month, there were higher rates of overall wound infections (OR 1.42, 95% CI 1.08-1.86, p=0.01) and wound infections after spinal surgery (OR 1.64, 95% CI 1.04-2.59, p=0.03). A separate analysis of three studies including 170,943 patients showed no significant difference in outcomes in teaching and non-teaching hospitals during the first academic month compared to the rest of the year.
Conclusion : The first academic month is linked to notably higher rates of wound infections, reoperations, and longer lengths of stay after spinal surgeries. Future robust randomized controlled trials are needed to investigate the impact of this period on outcomes for different subtypes of cranial and spinal surgeries across various neuro-spinal pathologies.
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