Inguinal hernia surgery learning curves by associate clinicians.

Autor: van Kesteren J; Department of Surgery, Amsterdam University Medical Centers, Location Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. j.vankesteren@amsterdamumc.nl.; Global Surgery Amsterdam, Amsterdam, The Netherlands. j.vankesteren@amsterdamumc.nl., Meylahn-Jansen PJ; Global Surgery Amsterdam, Amsterdam, The Netherlands.; Department of Internal Medicine, Haaglanden Medical Center, The Hague, The Netherlands., Conteh A; Masanga Hospital, Tonkolili, Sierra Leone., Lissenberg-Witte BI; Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Location Vrije Universiteit, Amsterdam, The Netherlands., van Duinen AJ; Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.; Clinic of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway.; CapaCare, Trondheim, Norway., Ashley T; CapaCare, Trondheim, Norway.; Kamakwie Wesleyan Hospital, Kamakwie, Sierra Leone.; Department of General Surgery, North Cumbria University Hospital, Carlisle, UK., Bonjer HJ; Department of Surgery, Amsterdam University Medical Centers, Location Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.; Global Surgery Amsterdam, Amsterdam, The Netherlands., Bolkan HA; Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.; Clinic of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway.; CapaCare, Trondheim, Norway.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2023 Mar; Vol. 37 (3), pp. 2085-2094. Date of Electronic Publication: 2022 Oct 27.
DOI: 10.1007/s00464-022-09726-5
Abstrakt: Background: Open inguinal hernia repair is the most commonly performed procedure in general surgery in sub-Saharan Africa, but data on its learning curve are lacking. This study evaluated the learning curve characteristics to improve surgical training and enable scaling up hernia surgery in low- and middle-income countries.
Methods: Logbook data of associate clinicians enrolled in a surgical training program in Sierra Leone were collected and their first 55 hernia surgeries following the Bassini technique (herniorrhaphies) were analyzed in cohorts of five cases. Studied variables were gradient of decline of operating time, variation in operating time, and length of stay (LOS). Eleven subsequent cohorts of each five herniorrhaphies were investigated.
Results: Seventy-five trainees enrolled in the training program between 2011 and 2020 were eligible for inclusion. Thirty-one (41.3%) performed the minimum of 55 herniorrhaphies, and had also complete personal logbook data. Mean operating times dropped from 79.6 (95% CI 75.3-84.0) to 48.6 (95% CI 44.3-52.9) minutes between the first and last cohort, while standard deviation in operating time nearly halved to 15.4 (95% CI 11.7-20.0) minutes, and LOS was shortened by 3 days (8.5 days, 95%CI 6.1-10.8 vs. 5.4 days, 95% 3.1-7.6). Operating times flattened after 31-35 cases which corresponded with 1.5 years of training.
Conclusions: The learning curve of inguinal hernia surgery for associate clinicians flattens after 31-35 procedures. Training programs can be tailored based on this finding. The recorded learning curve may serve as a baseline for future training techniques.
(© 2022. The Author(s).)
Databáze: MEDLINE
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