Analysis of Laparoscopic Sleeve Gastrectomy Learning Curve and Its Influence on Procedure Safety and Perioperative Complications
| Autor: | Magdalena Pisarska, Mateusz Wierdak, Michał Natkaniec, Michał Wysocki, Michał Pędziwiatr, Piotr Major, Piotr Małczak, Andrzej Budzyński, Anna Zub-Pokrowiecka, Michał Nowakowski, Jadwiga Dworak |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Adult
medicine.medical_specialty Endocrinology Diabetes and Metabolism Original Contributions Surgical training Clinical competence 030209 endocrinology & metabolism Teaching hospital 03 medical and health sciences 0302 clinical medicine Postoperative Complications Gastrectomy Clinical endpoint Medicine Humans Adverse effect Enhanced recovery after surgery Learning curve Retrospective Studies Laparoscopic sleeve gastrectomy Nutrition and Dietetics business.industry Mortality rate Retrospective cohort study Perioperative Middle Aged Surgery Obesity Morbid 030211 gastroenterology & hepatology Laparoscopy business |
| Zdroj: | Obesity Surgery |
| Popis: | Purpose Laparoscopic sleeve gastrectomy (LSG) has become an attractive bariatric procedure with promising treatment effects yet amount of data regarding institutional learning process is limited. Materials and Methods Retrospective study included patients submitted to LSG at academic teaching hospital. Patients were divided into groups every 100 consecutive patients. LSG introduction was structured along with Enhanced Recovery after Surgery (ERAS) treatment protocol. Primary endpoint was determining the LSG learning curve’s stabilization point, using operative time, intraoperative difficulties, intraoperative adverse events (IAE), and number of stapler firings. Secondary endpoints: influence on perioperative complications and reoperations. Five hundred patients were included (330 females, median age of 40 (33–49) years). Results Operative time in G1–G2 differed significantly from G3–G5. Stabilization point was the 200th procedure using operative time. Intraoperative difficulties of G1 differed significantly from G2–G5, with stabilization after the 100th procedure. IAE and number of stapler firings could not be used as predictor. Based on perioperative morbidity, the learning curve was stabilized at the 100th procedure. The morbidity rates in the groups were G1, 13%; G2, 4%; G3, 5%; G4, 5%; and G5, 2%. The reoperation rate in G1 was 3%; G2, 2%; G3, 2%; G4, 1%; and G5, 0%. Conclusion The institutional learning process stabilization point for LSG in a newly established bariatric center is between the 100th and 200th operation. Initially, the morbidity rate is high, which should concern surgeons who are willing to perform bariatric surgery. |
| Databáze: | OpenAIRE |
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