The current state of academic neurosurgery: A national survey assessing academic neurosurgical capacity and perceived needs

Background

While inequities in the provision of neurosurgical care exist worldwide, the specific challenges in academic neurosurgical capacity remain inadequately understood. We sought to evaluate current neurosurgical capacity in United States academic tertiary care centers with neurosurgical residency programs and assess perceived needs in their respective practice settings.

Methods

An online survey regarding human resources, medications, equipment, and infrastructure was distributed to all 117 residency programs in the US. Institutions were categorized using the Area Deprivation Index (ADI), a tool quantifying socioeconomic disadvantage, into low (0–50) or high (51–100) groups.

Results

Responses from 37 institutions were recorded (59 % low ADI, 41 % high ADI). Common limitations included shortages of floor beds (84 %), nurses (81 %), and Neurocritical Care Unit (NCCU) beds (77 %). The least available equipment were intraoperative MRI (49 % total, Low ADI: 59 %, High ADI: 33 %, p = 0.18) and exoscopes (51 % total, Low ADI: 59 %, High ADI:40 %, p = 0.32). The most desired change in human resources was more operating room (OR) nurses (86 %, Low ADI: 77 %, High ADI: 100 %, p = 0.07) and the most common desired infrastructural changes were for more ORs (81 % total, Low ADI: 73 %, High ADI: 93 %, p = 0.2), floor beds (70 % total, Low ADI:59 %, High ADI:87 %, p = 0.14) and NCCU beds (70 % total, Low ADI: 68 %, High ADI:73 %, p = 1.0).

Conclusions

Academic centers across the US may face challenges related to advanced equipment, infrastructure, and personnel. More deprived programs may experience greater limitations. Interventions to address these limitations may be necessary, but further research is needed to comprehensively and objectively assess neurosurgical capacity.