{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T09:04:59Z","timestamp":1780131899724,"version":"3.54.0"},"reference-count":56,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n 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\u2019 knowledge, to assess operative efficiency metrics between cases performed with and without resident involvement at an ambulatory neurosurgical center.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n As a higher volume of routine spine surgeries transitions into the ambulatory setting, balancing efficiency with resident education becomes increasingly critical. The authors\u2019 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2026.1.focus251087","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T02:27:02Z","timestamp":1775010422000},"page":"E8","source":"Crossref","is-referenced-by-count":0,"title":["Impact of resident involvement on operative efficiency in an ambulatory neurosurgical center: a comparative analysis of spine surgery cases"],"prefix":"10.3171","volume":"60","author":[{"given":"Rory","family":"Hagstrom","sequence":"first","affiliation":[{"name":"Jacobs School of Medicine and Biomedical Sciences at University at Buffalo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asham","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo;"},{"name":"Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed A. R.","family":"Soliman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo;"},{"name":"Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York;"},{"name":"Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle G.","family":"Stockman","sequence":"additional","affiliation":[{"name":"Jacobs School of Medicine and Biomedical Sciences at University at Buffalo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke","family":"Hobika","sequence":"additional","affiliation":[{"name":"Jacobs School of Medicine and Biomedical Sciences at University at Buffalo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christa C.","family":"MacLean","sequence":"additional","affiliation":[{"name":"Atlas Surgery Center, Williamsville;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey P.","family":"Mullin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo;"},{"name":"Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York;"},{"name":"Atlas Surgery Center, Williamsville;"},{"name":"Department of Biomedical Engineering, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas B.","family":"Moreland","sequence":"additional","affiliation":[{"name":"Jacobs School of Medicine and Biomedical Sciences at University at Buffalo;"},{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo;"},{"name":"Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York;"},{"name":"Atlas Surgery Center, Williamsville;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elad I.","family":"Levy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo;"},{"name":"Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York;"},{"name":"Atlas Surgery Center, Williamsville;"},{"name":"Canon Stroke and Vascular Research Center, University at Buffalo;"},{"name":"Jacobs Institute, Buffalo; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Neurosurgery","first-page":"963","article-title":"Neurosurgical utilization, charges, and reimbursement after the Affordable Care Act: trends from 2011 to 2019","volume":"92","author":"Hersh AM","year":"2023","unstructured":"Hersh AM, Dedrickson T, Gong JH, Neurosurgical utilization, charges, and reimbursement after the Affordable Care Act: trends from 2011 to 2019. Neurosurgery. 2023;92(5):963\u2013970. doi:10.1227\/neu.0000000000002306"},{"issue":"5","key":"b2","series-title":"Health Aff (Millwood)","first-page":"764","article-title":"Procedures take less time at ambulatory surgery centers, keeping costs down and ability to meet demand up","volume":"33","author":"Munnich EL","year":"2014","unstructured":"Munnich EL, Parente ST. Procedures take less time at ambulatory surgery centers, keeping costs down and ability to meet demand up. Health Aff (Millwood). 2014;33(5):764\u2013769. doi:10.1377\/hlthaff.2013.1281"},{"issue":"5","key":"b3","series-title":"Plast Reconstr Surg","first-page":"1149","article-title":"Joint-venture ambulatory surgery centers: the perfect partnership","volume":"148","author":"Tanna N","year":"2021","unstructured":"Tanna N, Gibstein AR, Boll A, Joint-venture ambulatory surgery centers: the perfect partnership. Plast Reconstr Surg. 2021;148(5):1149\u20131156. doi:10.1097\/PRS.0000000000008423"},{"issue":"3","key":"b4","series-title":"Spine (Phila Pa 1976)","first-page":"155","article-title":"Anterior cervical discectomy and fusion in the ambulatory surgery center versus inpatient setting: one-year cost-utility analysis","volume":"48","author":"Monk SH","year":"2023","unstructured":"Monk SH, Hani U, Pfortmiller D, Anterior cervical discectomy and fusion in the ambulatory surgery center versus inpatient setting: one-year cost-utility analysis. Spine (Phila Pa 1976). 2023;48(3):155\u2013163. doi:10.1097\/BRS.0000000000004500"},{"issue":"5","key":"b5","series-title":"J Am Acad Orthop Surg","first-page":"207","article-title":"Ambulatory surgery centers versus hospital outpatient departments for orthopaedic surgeries","volume":"30","author":"Wang KY","year":"2022","unstructured":"Wang KY, Puvanesarajah V, Marrache M, Ficke JR, Levy JF, Jain A. Ambulatory surgery centers versus hospital outpatient departments for orthopaedic surgeries. J Am Acad Orthop Surg. 2022;30(5):207\u2013214. doi:10.5435\/JAAOS-D-21-00739"},{"issue":"2","key":"b6","series-title":"J Arthroplasty","first-page":"268","article-title":"Practical implications of value-based care in the setting of ambulatory surgery centers","volume":"40","author":"Hung IY","year":"2025","unstructured":"Hung IY, Jevsevar DS, Simonson T, Kain ZN. Practical implications of value-based care in the setting of ambulatory surgery centers. J Arthroplasty. 2025;40(2):268\u2013271. doi:10.1016\/j.arth.2024.11.027"},{"issue":"10","key":"b7","series-title":"J Shoulder Elbow Surg","first-page":"2123","article-title":"Costs of shoulder and elbow procedures are significantly reduced in ambulatory surgery centers compared to hospital outpatient departments","volume":"32","author":"Federico VP","year":"2023","unstructured":"Federico VP, McCormick JR, Nie JW, Costs of shoulder and elbow procedures are significantly reduced in ambulatory surgery centers compared to hospital outpatient departments. 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J Arthroplasty. 2025;40(2):268\u2013271. doi:10.1016\/j.arth.2024.11.027"},{"issue":"10","key":"b7","series-title":"J Shoulder Elbow Surg","first-page":"2123","article-title":"Costs of shoulder and elbow procedures are significantly reduced in ambulatory surgery centers compared to hospital outpatient departments","volume":"32","author":"Federico VP","year":"2023","unstructured":"Federico VP, McCormick JR, Nie JW, Costs of shoulder and elbow procedures are significantly reduced in ambulatory surgery centers compared to hospital outpatient departments. 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