TY - JOUR
T1 - Learning Curve and Associated Morbidity of Minimally Invasive Esophagectomy: A Retrospective Multicenter Study
AU - van Workum, Frans
AU - Stenstra, Marianne H. B. C.
AU - Berkelmans, Gijs H. K.
AU - Slaman, Annelijn E.
AU - van Berge Henegouwen, Mark I.
AU - Gisbertz, Suzanne S.
AU - van den Wildenberg, Frits J. H.
AU - Polat, Fatih
AU - Irino, Tomoyuki
AU - Nilsson, Magnus
AU - Nieuwenhuijzen, Grard A. P.
AU - Luyer, Misha D.
AU - Adang, Eddy M.
AU - Hannink, Gerjon
AU - Rovers, Maroeska M.
AU - Rosman, Camiel
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Objective: To investigate the morbidity that is associated with the learning curve of minimally invasive esophagectomy. Background: Although learning curves have been described, it is currently unknown how much extra morbidity is associated with the learning curve of technically challenging surgical procedures. Methods: Prospectively collected data were retrospectively analyzed of all consecutive patients undergoing minimally invasive Ivor Lewis esophagectomy in 4 European expert centers. The primary outcome parameter was anastomotic leakage. Secondary outcome parameters were operative time and textbook outcome ("optimal outcome"). Learning curves were plotted using weighted moving average and CUSUM analysis was used to determine after how many cases the plateau was reached. Learning associated morbidity was calculated with area under the curve analysis. Results: This study included 646 patients. Three of the 4 hospitals reached the plateau of 8% anastomotic leakage. The length of the learning curve was 119 cases. The mean incidence of anastomotic leakage decreased from 18.8% during the learning phase to 4.5% after the plateau had been reached (P < 0.001). Thirty-six extra patients (10.1% of all patients operated on during the learning curve) experienced learning associated anastomotic leakage, that could have been avoided if patients were operated by surgeons who had completed the learning curve. The incidence of textbook outcome increased from 28% to 53% and the mean operative time decreased from 344 minutes to 270 minutes. Conclusions: A considerable number of 36 extra patients (10.1%) experienced learning associated anastomotic leakage. More research is urgently needed to investigate how learning associated morbidity can be reduced to increase patient safety during learning curves.
AB - Objective: To investigate the morbidity that is associated with the learning curve of minimally invasive esophagectomy. Background: Although learning curves have been described, it is currently unknown how much extra morbidity is associated with the learning curve of technically challenging surgical procedures. Methods: Prospectively collected data were retrospectively analyzed of all consecutive patients undergoing minimally invasive Ivor Lewis esophagectomy in 4 European expert centers. The primary outcome parameter was anastomotic leakage. Secondary outcome parameters were operative time and textbook outcome ("optimal outcome"). Learning curves were plotted using weighted moving average and CUSUM analysis was used to determine after how many cases the plateau was reached. Learning associated morbidity was calculated with area under the curve analysis. Results: This study included 646 patients. Three of the 4 hospitals reached the plateau of 8% anastomotic leakage. The length of the learning curve was 119 cases. The mean incidence of anastomotic leakage decreased from 18.8% during the learning phase to 4.5% after the plateau had been reached (P < 0.001). Thirty-six extra patients (10.1% of all patients operated on during the learning curve) experienced learning associated anastomotic leakage, that could have been avoided if patients were operated by surgeons who had completed the learning curve. The incidence of textbook outcome increased from 28% to 53% and the mean operative time decreased from 344 minutes to 270 minutes. Conclusions: A considerable number of 36 extra patients (10.1%) experienced learning associated anastomotic leakage. More research is urgently needed to investigate how learning associated morbidity can be reduced to increase patient safety during learning curves.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85058899575&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/28857809
U2 - https://doi.org/10.1097/SLA.0000000000002469
DO - https://doi.org/10.1097/SLA.0000000000002469
M3 - Article
C2 - 28857809
SN - 0003-4932
VL - 269
SP - 88
EP - 94
JO - Annals of Surgery
JF - Annals of Surgery
IS - 1
ER -