2025 Proffered Presentations
S147: VALUE OF ADVANCED PRACTICE PROVIDERS IN FOSTERING THE DEVELOPMENT OF ELECTIVE EARLY ACADEMIC SKULL BASE PRACTICE WITHOUT RESIDENTS/FELLOWS IN A TERTIARY ACADEMIC CENTER: A UNIFIED SKULL BASE
Ursula N Hummel, MHS, PAC; Adnan H Shahid, MBBS, MS, MCh; Mehdi Khaleghi, MD; Danielle N Chason, BCAGACNP, RNFA; Danner W Butler, MS; Garrett Dyess, BA; Maxon Bassett, MS; Jai D Thakur, MD, FAANS; University of South Alabama
Introduction: Advanced Practice Providers (APP’s) have a growing contribution in neurosurgery. No previous study has investigated their value in development of a skull-base surgeon’s initial practice. The goal of this study is to assess the influence and support of APPs in development of elective early academic skull base practice in a non-neurosurgical residency program at a tertiary academic center.
Methods: A retrospective chart review of first three years of elective skull base cases of a single skull base surgeon was done. Data was obtained including the following: Total number of cases in which first assist included 1 APP, 2 APPs, 1MD+1APP or 1 MD were documented. Non-elective cranial and skull base cases were excluded from the analysis. We assessed duration of surgery; type of cranial skull-base approach and highlighting postoperative complications and its implications of APP’s in postoperative care as well. The statistical analysis was performed using multiple tests including ANOVA, Student-t, Fisher’s exact, and Chi-square tests.
Results: Of the total 203 elective cranial surgeries, 139 patients with various skull base pathologies were included. 104/139 patients were categorized in the APP-FA group, of which “1 APP” was the FA in 90/139 patients (64.7%), “2 APPs” in 6 (4.3%), and “1 APP+1 MD” in 8 patients (5.7%). The overall mean duration of the surgeries scrubbed by APPs was 372 ± 156 minutes (min), ranging from 137-793 min. There was no significant difference in mean duration between MD-FA and APP-FA groups (286.6 ± 124.56 min vs 305.8 ± 117.823 min, p=0.413). The mean duration in 1 APP, 2 APPs, and 1 APP+1 MD subgroups were 290.43 ± 95.67, 455.17 ± 217.91, 366.63 ± 166.04, and 286.60 ± 124.56 min, respectively, with the 1 MD subgroup showed significantly lower surgical duration than two-APP subgroup (p=0.006). Subgroup analysis in patients with endoscopic endonasal surgery (EEA) and anterior/middle skull base surgeries showed no significant difference in mean surgical duration between MD- and APP-groups. In the EEA cohort, APPs were the first assistants without an ENT surgeon in 23/58 (39.6%) elective cases with a mean surgical duration of 239 ± 74 min. Overall, in 104 patients where APPs were the first assistant, wound infection was noted in 1 case (<1%). In cranial cohort, no pseudomeningocele/CSF leak was noted. However, in endonasal cohort, 1 patient developed CSF leak in postoperative period. Even though posterior skull base surgeries were significantly longer than their anterior/middle counterpart (349 ± 129 vs. 272 ± 104 min, p< 0.001 ), the overall participation of the APPs as the first assistant was still higher in posterior fossa surgeries (94.1% versus 5.9%, p< 0.001).
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Conclusion: Advanced Practice Providers (APPs) played a significant role in the perioperative care within the first 3 years of practice without having residents/fellows at a tertiary academic center. Their involvement in long cases were quintessential for success of the patient care. In 40% cases, APPs were first assist in endonasal cases. Overall, the complication rates remained low regardless of the number of APP’s scrubbed or in comparison with MD assist.