Learning Curve of Autologous Arteriovenous Fistula Formation for Junior Vascular Surgeons.

Autor:	Choi MC; Department of Surgery, Armed Forces Capital Hospital, Seongnam, Korea., Yim SH; Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.; Department of Surgery, Yongin Severance Hospital, Yongin, Korea., Shin SW; Division of Vascular and Endovascular Sugery, Department of Surgery, Samil Hospital, Daegu, Korea., Yang SJ; Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea., Kim DG; Department of Surgery, Yonsei University College of Medicine, Seoul, Korea., Heo SH; Department of Surgery, Yonsei University College of Medicine, Seoul, Korea., Kim SJ; Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Jazyk:	angličtina
Zdroj:	Vascular specialist international [Vasc Specialist Int] 2024 Nov 19; Vol. 40, pp. 37. Date of Electronic Publication: 2024 Nov 19.
DOI:	10.5758/vsi.240049
Abstrakt:	Purpose: Autologous arteriovenous fistulas (AVFs) are considered the gold standard for hemodialysis access, with outcomes largely dependent on the surgeon's experience. Nevertheless, few studies have been conducted on the learning curve of junior vascular surgeons in AVF creation. This study aims to address this by examining the development of surgical skills among junior vascular surgeons. Materials and Methods: A retrospective analysis was conducted on 100 patients who underwent autologous AVF procedures performed by five junior surgeons between January 2018 and December 2023. To establish the cutoff number of cases for the learning curve, we examined the cubic spline curve using the hazard ratio for primary failure. Results: The cutoff number for operation cases was 15.33, and we divided the analysis into a pre-learning curve period (≤15 cases of AVF) and a post-learning curve period (>15 cases of AVF). The 1-year primary patency rate for AVF during the post-learning curve period was 84.0%, which was higher than the 65.5% rate observed during the pre-learning curve period. In a subgroup analysis based on AVF type, the radiocephalic fistula patient group demonstrated a significant increase in 1-year primary patency in the post-learning curve period compared to that in the pre-learning curve period (80.0% vs. 43.0%, log-rank P=0.033). In contrast, there was no significant difference in the primary patency rates between the post- and pre-learning curve periods in the brachiocephalic fistula patient group (90.0% vs. 89.2%, log-rank P=0.930). Conclusion: Junior vascular surgeons demonstrated improved primary AVF patency beyond the learning curve benchmark in 15 patients, with particularly notable enhancements in radiocephalic fistulas.
Databáze:	MEDLINE
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