Impact of resident involvement on operative efficiency in an ambulatory neurosurgical center: a comparative analysis of spine surgery cases

OBJECTIVE: The utilization of ambulatory surgical centers in neurosurgery has increased dramatically over the past decade. With this growth, it is important to evaluate performance metrics, including patient care and operational outcomes. Additionally, it is vital to understand how resident education should evolve to reflect this shift. This comparative analysis is the first, to the authors' knowledge, to assess operative efficiency metrics between cases performed with and without resident involvement at an ambulatory neurosurgical center. METHODS: The authors performed a retrospective chart review to identify resident cases (performed between October 1, 2024, and March 31, 2025) and nonresident cases (performed between April 1, 2024, and September 31, 2024, after the center was approved for resident training), matched across 6 procedure types. Two-sample t-tests were performed to evaluate significant (p < 0.05) differences in operating room time (ORT), procedure time (PT), and turnover time (TOT) between cases with and without resident involvement. A chi-square test was conducted to compare the frequency of complications between the same subgroups. This report was completed in accordance with STROBE guidelines. RESULTS: Of 396 total cases, those with resident involvement (n = 195) demonstrated significantly increased ORT and PT for lumbar fusions (ORT: p = 0.004, PT: p = 0.004), lumbar nonfusions (ORT: p = 0.02, PT: p = 0.04), and sacroiliac fusions (ORT: p = 0.03, PT: p = 0.01). In cervical nonfusions, ORT did not significantly differ between cases with and without residents. However, in cervical nonfusion cases with residents, PT was significantly shorter (p < 0.001) and TOT significantly longer (p < 0.001). Additionally, lumbar fusion cases with residents demonstrated significantly shorter TOT (p = 0.04). ORT, PT, and TOT metrics showed no significant differences between cases with and without residents in cervical fusions and thoracic SCS. TOT did not differ significantly between groups for lumbar nonfusions and sacroiliac fusions. CONCLUSIONS: As a higher volume of routine spine surgeries transitions into the ambulatory setting, balancing efficiency with resident education becomes increasingly critical. The authors' findings underscore the importance of implementing deliberate strategies to preserve resident involvement without compromising the cost-effectiveness and high patient care standards inherent to the ambulatory surgical center model.