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Hospital versus individual surgeon’s performance in laparoscopic hysterectomy
PURPOSE: To compare hospital versus individual surgeon’s perioperative outcomes for laparoscopic hysterectomy (LH), and to assess the relationship between surgeon experience and perioperative outcomes. METHODS: A retrospective analysis of all prospective collected LHs performed from 2003 to 2010 at...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5225188/ https://www.ncbi.nlm.nih.gov/pubmed/27628752 http://dx.doi.org/10.1007/s00404-016-4199-2 |
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author | Driessen, Sara R. C. Wallwiener, Markus Taran, Florin-Andrei Cohen, Sarah L. Kraemer, Bernhard Wallwiener, Christian W. van Zwet, Erik W. Brucker, Sara Y. Jansen, Frank Willem |
author_facet | Driessen, Sara R. C. Wallwiener, Markus Taran, Florin-Andrei Cohen, Sarah L. Kraemer, Bernhard Wallwiener, Christian W. van Zwet, Erik W. Brucker, Sara Y. Jansen, Frank Willem |
author_sort | Driessen, Sara R. C. |
collection | PubMed |
description | PURPOSE: To compare hospital versus individual surgeon’s perioperative outcomes for laparoscopic hysterectomy (LH), and to assess the relationship between surgeon experience and perioperative outcomes. METHODS: A retrospective analysis of all prospective collected LHs performed from 2003 to 2010 at one medical center was performed. Perioperative outcomes (operative time, blood loss, complication rate) were assessed on both a hospital level and surgeon level using Cumulative Observed minus Expected performance graphs. RESULTS: A total of 1618 LHs were performed, 16 % total laparoscopic hysterectomies and 84 % laparoscopic supracervical hysterectomies. Overall outcomes included mean (SD±) blood loss 108.9 ± 69.2 mL, mean operative time 95.4 ± 39.7 min and a complication occurred in 76 (4.7 %) of cases. Suboptimal perioperative outcomes of an individual surgeon were not always detected on a hospital level. However, collective suboptimal outcomes were faster detected on a hospital level compared to individual surgeon’s level. Evidence of a learning curve is seen; for the first 100 procedures, a decrease in operative time is observed as individual surgeon experience increases. Similarly, the risk of conversion decreases up to the first 50 procedures. CONCLUSION: An individual outlier (i.e., surgeon with consistently suboptimal performance) will not always be detected when monitoring outcome measures only on a hospital level. However, monitoring outcome measures on a hospital level will detect suboptimal performance earlier compared to monitoring only on an individual surgeon’s level. To detect performance outliers timely, insight into an individual surgeon’s outcome and skills is recommended. Furthermore, an experienced surgeon is no guarantee for acceptable surgical outcomes. |
format | Online Article Text |
id | pubmed-5225188 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-52251882017-01-24 Hospital versus individual surgeon’s performance in laparoscopic hysterectomy Driessen, Sara R. C. Wallwiener, Markus Taran, Florin-Andrei Cohen, Sarah L. Kraemer, Bernhard Wallwiener, Christian W. van Zwet, Erik W. Brucker, Sara Y. Jansen, Frank Willem Arch Gynecol Obstet General Gynecology PURPOSE: To compare hospital versus individual surgeon’s perioperative outcomes for laparoscopic hysterectomy (LH), and to assess the relationship between surgeon experience and perioperative outcomes. METHODS: A retrospective analysis of all prospective collected LHs performed from 2003 to 2010 at one medical center was performed. Perioperative outcomes (operative time, blood loss, complication rate) were assessed on both a hospital level and surgeon level using Cumulative Observed minus Expected performance graphs. RESULTS: A total of 1618 LHs were performed, 16 % total laparoscopic hysterectomies and 84 % laparoscopic supracervical hysterectomies. Overall outcomes included mean (SD±) blood loss 108.9 ± 69.2 mL, mean operative time 95.4 ± 39.7 min and a complication occurred in 76 (4.7 %) of cases. Suboptimal perioperative outcomes of an individual surgeon were not always detected on a hospital level. However, collective suboptimal outcomes were faster detected on a hospital level compared to individual surgeon’s level. Evidence of a learning curve is seen; for the first 100 procedures, a decrease in operative time is observed as individual surgeon experience increases. Similarly, the risk of conversion decreases up to the first 50 procedures. CONCLUSION: An individual outlier (i.e., surgeon with consistently suboptimal performance) will not always be detected when monitoring outcome measures only on a hospital level. However, monitoring outcome measures on a hospital level will detect suboptimal performance earlier compared to monitoring only on an individual surgeon’s level. To detect performance outliers timely, insight into an individual surgeon’s outcome and skills is recommended. Furthermore, an experienced surgeon is no guarantee for acceptable surgical outcomes. Springer Berlin Heidelberg 2016-09-15 2017 /pmc/articles/PMC5225188/ /pubmed/27628752 http://dx.doi.org/10.1007/s00404-016-4199-2 Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | General Gynecology Driessen, Sara R. C. Wallwiener, Markus Taran, Florin-Andrei Cohen, Sarah L. Kraemer, Bernhard Wallwiener, Christian W. van Zwet, Erik W. Brucker, Sara Y. Jansen, Frank Willem Hospital versus individual surgeon’s performance in laparoscopic hysterectomy |
title | Hospital versus individual surgeon’s performance in laparoscopic hysterectomy |
title_full | Hospital versus individual surgeon’s performance in laparoscopic hysterectomy |
title_fullStr | Hospital versus individual surgeon’s performance in laparoscopic hysterectomy |
title_full_unstemmed | Hospital versus individual surgeon’s performance in laparoscopic hysterectomy |
title_short | Hospital versus individual surgeon’s performance in laparoscopic hysterectomy |
title_sort | hospital versus individual surgeon’s performance in laparoscopic hysterectomy |
topic | General Gynecology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5225188/ https://www.ncbi.nlm.nih.gov/pubmed/27628752 http://dx.doi.org/10.1007/s00404-016-4199-2 |
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