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Acta Neurochir (Wien). 2019 Mar 29. doi: 10.1007/s00701-019-03888-3. [Epub ahead of print]

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

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Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
Department of Clinical Neuroscience and Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark.
Department of Neurosurgery, Charité University Hospital, Berlin, Germany.
Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.
Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
HAGA Teaching Hospital and Medical Center Haaglanden, The Hague & Leiden University Medical Center, Leiden, Netherlands.
Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany.
Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain.
Department of Neurosurgery, RWTH Aachen University, Aachen, Germany.
Department of Neurosurgery, Western General Hospital, Edinburgh, UK.
Department of Neurosurgery, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany.
Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.



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.


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.


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).


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.


Caseload; Europe; Neurosurgery; Residency; Training program; Working hour restriction


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