TY - JOUR
T1 - Learning Curves of Ivor Lewis Totally Minimally Invasive Esophagectomy by Hospital and Surgeon Characteristics
T2 - A Retrospective Multinational Cohort Study
AU - Claassen, Linda
AU - Hannink, Gerjon
AU - Luyer, Misha D. P.
AU - Ainsworth, Alan P.
AU - Henegouwen, Mark I. van Berge
AU - Cheong, Edward
AU - Daams, Freek
AU - van Det, Marc J.
AU - van Duijvendijk, Peter
AU - Gisbertz, Suzanne S.
AU - Gutschow, Christian A.
AU - Heisterkamp, Joos
AU - Kauppi, Juha T.
AU - Klarenbeek, Bastiaan R.
AU - Kouwenhoven, Ewout A.
AU - Langenhoff, Barbara S.
AU - Larsen, Michael H.
AU - Martijnse, Ingrid S.
AU - Nieuwenhoven, Ernst Jan van
AU - van der Peet, Donald L.
AU - Pierie, Jean-Pierre E. N.
AU - Pierik, Robert E. G. J. M.
AU - Polat, Fatih
AU - Rusanen, Jari V.
AU - Rouvelas, Ioannis
AU - Sosef, Meindert N.
AU - Wassenaar, Eelco B.
AU - Wildenberg, Frits J. H. van den
AU - van der Zaag, Edwin S.
AU - Nilsson, Magnus
AU - Nieuwenhuijzen, Grard A. P.
AU - Esophagectomy Learning Curve Collaborative Group
AU - van Workum, Frans
AU - Rosman, Camiel
N1 - Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - Objective:To describe the pooled learning curves of Ivor Lewis totally minimally invasive esophagectomy (TMIE) in hospitals stratified by predefined hospital- and surgeon-related factors.Background:Ivor Lewis (TMIE is known to have a long learning curve which is associated with considerable learning associated morbidity. It is unknown whether hospital and surgeon characteristics are associated with more efficient learning.Methods:A retrospective analysis of prospectively collected data of consecutive Ivor Lewis TMIE patients in 14 European hospitals was performed. Outcome parameters used as proxy for efficient learning were learning curve length, learning associated morbidity, and the plateau level regarding anastomotic leakage and textbook outcome. Pooled incidences were plotted for the factor-based subgroups using generalized additive models and 2-phase models. Casemix predicted outcomes were plotted and compared with observed outcomes. The investigated factors included annual volume, TMIE experience, clinic visits, courses and fellowships followed, and proctor supervision.Results:This study included 2121 patients. The length of the learning curve was shorter for centers with an annual volume >50 compared to centers with an annual volume <50. Analysis with an annual volume cut-off of 30 cases showed similar but less pronounced results. No outcomes suggesting more efficient learning were found for longer experience as consultant, visiting an expert clinic, completing a minimally invasive esophagectomy fellowship or implementation under proctor supervision.Conclusions:More efficient learning was observed in centers with higher annual volume. Visiting an expert clinic, completing a fellowship, or implementation under a proctor's supervision were not associated with more efficient learning.
AB - Objective:To describe the pooled learning curves of Ivor Lewis totally minimally invasive esophagectomy (TMIE) in hospitals stratified by predefined hospital- and surgeon-related factors.Background:Ivor Lewis (TMIE is known to have a long learning curve which is associated with considerable learning associated morbidity. It is unknown whether hospital and surgeon characteristics are associated with more efficient learning.Methods:A retrospective analysis of prospectively collected data of consecutive Ivor Lewis TMIE patients in 14 European hospitals was performed. Outcome parameters used as proxy for efficient learning were learning curve length, learning associated morbidity, and the plateau level regarding anastomotic leakage and textbook outcome. Pooled incidences were plotted for the factor-based subgroups using generalized additive models and 2-phase models. Casemix predicted outcomes were plotted and compared with observed outcomes. The investigated factors included annual volume, TMIE experience, clinic visits, courses and fellowships followed, and proctor supervision.Results:This study included 2121 patients. The length of the learning curve was shorter for centers with an annual volume >50 compared to centers with an annual volume <50. Analysis with an annual volume cut-off of 30 cases showed similar but less pronounced results. No outcomes suggesting more efficient learning were found for longer experience as consultant, visiting an expert clinic, completing a minimally invasive esophagectomy fellowship or implementation under proctor supervision.Conclusions:More efficient learning was observed in centers with higher annual volume. Visiting an expert clinic, completing a fellowship, or implementation under a proctor's supervision were not associated with more efficient learning.
KW - Ivor Lewis totally minimally invasive esophagectomy
KW - efficient learning
KW - learning curves
UR - http://www.scopus.com/inward/record.url?scp=85130001246&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/SLA.0000000000004801
DO - https://doi.org/10.1097/SLA.0000000000004801
M3 - Article
C2 - 33605581
SN - 0003-4932
VL - 275
SP - 911
EP - 918
JO - Annals of surgery
JF - Annals of surgery
IS - 5
ER -