Operative time is a poor surrogate for the learning curve in laparoscopic colorectal surgery
| Autor: | Elizabeth A. Sailhamer, David H. Berger, W. Chen, David W. Rattner |
|---|---|
| Rok vydání: | 2007 |
| Předmět: |
Adult
Male Laparoscopic surgery medicine.medical_specialty Time Factors medicine.medical_treatment Patient Readmission Risk Assessment Postoperative Complications medicine Humans Intraoperative Complications Aged Retrospective Studies Aged 80 and over business.industry Incidence Follow up studies Retrospective cohort study Colonoscopy Length of Stay Middle Aged Colorectal surgery Surgery Treatment Outcome Learning curve Operative time Female Clinical Competence Colorectal Neoplasms Complication business Colorectal Surgery Follow-Up Studies Abdominal surgery |
| Zdroj: | Surgical Endoscopy. 21:238-243 |
| ISSN: | 1432-2218 0930-2794 |
| Popis: | Previous studies have relied on conversion rate and operative time for construction of learning curves in laparoscopic colorectal surgery. The authors hypothesized that conversion rate and operative time were less important than complication and readmission rates in defining good outcomes and hence the learning curve.A database of 287 consecutive laparoscopic colorectal resections from a single tertiary referral center was analyzed. Outcome measures included operative time, conversion rate, major and minor complications, length of hospital stay, and the 15- and 30-day hospital readmission rate. Data were analyzed both by surgeons and by quartile case numbers.A total of 151 right colectomies and 136 left colectomies were performed between 1995 and 2005. For both right and left colectomies, the conversion rate decreased in each of the first three quartiles, reaching a nadir of 0% for right colectomies and 3% for left colectomies in the third quartile. The conversion rates increased slightly in the fourth quartile. The operative time remained stable for three quartiles, then increased slightly in the fourth quartile. Two surgeons managed 199 of the 287 cases. Analysis of the two high-volume surgeons demonstrated that for left-sided resections, the surgeon with the shorter operative times had the higher major complication rate (13% vs 2%), overall complication rate (22% vs 2%), 30-day readmission rate (13% vs 0%), and length of stay (3.8 vs 3.1 days) (p0.05 for all comparisons).In this series, operative time failed to decrease with experience, and shorter operative times did not correlate with better clinical outcomes. The failure of operative time to decline with experience often reflects surgeons' willingness to attempt more difficult cases rather than an accurate representation of a "learning curve." Therefore, complication and readmission rates are more important than operative time and conversion rates for evaluating the learning curve and quality of laparoscopic colorectal surgery. |
| Databáze: | OpenAIRE |
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