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The influence of procedural volume and proficiency gain on mortality from upper GI endoscopic mucosal resection
OBJECTIVE: Endoscopic mucosal resection (EMR) is established for the management of benign and early malignant upper GI disease. The aim of this observational study was to establish the effect of endoscopist procedural volume on mortality. DESIGN: Patients undergoing upper GI EMR between 1997 and 201...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5754854/ https://www.ncbi.nlm.nih.gov/pubmed/27797934 http://dx.doi.org/10.1136/gutjnl-2015-311237 |
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author | Markar, Sheraz R Mackenzie, Hugh Ni, Melody Huddy, Jeremy R Askari, Alan Faiz, Omar Griffin, S Michael Lovat, Laurence Hanna, George B |
author_facet | Markar, Sheraz R Mackenzie, Hugh Ni, Melody Huddy, Jeremy R Askari, Alan Faiz, Omar Griffin, S Michael Lovat, Laurence Hanna, George B |
author_sort | Markar, Sheraz R |
collection | PubMed |
description | OBJECTIVE: Endoscopic mucosal resection (EMR) is established for the management of benign and early malignant upper GI disease. The aim of this observational study was to establish the effect of endoscopist procedural volume on mortality. DESIGN: Patients undergoing upper GI EMR between 1997 and 2012 were identified from the Hospital Episode Statistics database. The primary outcome was 30-day mortality and secondary outcomes were 90-day mortality, requirement for emergency intervention and elective cancer re-intervention. Risk-adjusted cumulative sum (RA-CUSUM) analysis was used to assess patient mortality risk during initial stage of endoscopist proficiency gain and the effect of endoscopist and hospital volume. Mortality was compared before and after the change point or threshold in the RA-CUSUM curve. RESULTS: 11 051 patients underwent upper GI EMR. Endoscopist procedure volume was an independent predictor of 30-day mortality. Fifty-eight per cent of EMR procedures were performed by endoscopists with annual volume of 2 cases or less, and had a higher 30-day and 90-day mortality rate for patients with cancer, 6.1% vs 0.4% (p<0.001) and 12% vs 2.1% (p<0.001), respectively. The requirement for emergency intervention after EMR for cancer was also greater with low volume endoscopists (1.8% vs 0.1%, p=0.002). In patients with cancer, the RA-CUSUM curve change points for 30-day mortality and elective re-intervention were 4 cases and 43 cases, respectively. CONCLUSIONS: EMR performed by high volume endoscopists is associated with reduced adverse outcomes. In order to reach proficiency, appropriate training and procedural volume accreditation training programmes are needed nationally. |
format | Online Article Text |
id | pubmed-5754854 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-57548542018-02-12 The influence of procedural volume and proficiency gain on mortality from upper GI endoscopic mucosal resection Markar, Sheraz R Mackenzie, Hugh Ni, Melody Huddy, Jeremy R Askari, Alan Faiz, Omar Griffin, S Michael Lovat, Laurence Hanna, George B Gut Endoscopy OBJECTIVE: Endoscopic mucosal resection (EMR) is established for the management of benign and early malignant upper GI disease. The aim of this observational study was to establish the effect of endoscopist procedural volume on mortality. DESIGN: Patients undergoing upper GI EMR between 1997 and 2012 were identified from the Hospital Episode Statistics database. The primary outcome was 30-day mortality and secondary outcomes were 90-day mortality, requirement for emergency intervention and elective cancer re-intervention. Risk-adjusted cumulative sum (RA-CUSUM) analysis was used to assess patient mortality risk during initial stage of endoscopist proficiency gain and the effect of endoscopist and hospital volume. Mortality was compared before and after the change point or threshold in the RA-CUSUM curve. RESULTS: 11 051 patients underwent upper GI EMR. Endoscopist procedure volume was an independent predictor of 30-day mortality. Fifty-eight per cent of EMR procedures were performed by endoscopists with annual volume of 2 cases or less, and had a higher 30-day and 90-day mortality rate for patients with cancer, 6.1% vs 0.4% (p<0.001) and 12% vs 2.1% (p<0.001), respectively. The requirement for emergency intervention after EMR for cancer was also greater with low volume endoscopists (1.8% vs 0.1%, p=0.002). In patients with cancer, the RA-CUSUM curve change points for 30-day mortality and elective re-intervention were 4 cases and 43 cases, respectively. CONCLUSIONS: EMR performed by high volume endoscopists is associated with reduced adverse outcomes. In order to reach proficiency, appropriate training and procedural volume accreditation training programmes are needed nationally. BMJ Publishing Group 2018-01 2016-10-18 /pmc/articles/PMC5754854/ /pubmed/27797934 http://dx.doi.org/10.1136/gutjnl-2015-311237 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Endoscopy Markar, Sheraz R Mackenzie, Hugh Ni, Melody Huddy, Jeremy R Askari, Alan Faiz, Omar Griffin, S Michael Lovat, Laurence Hanna, George B The influence of procedural volume and proficiency gain on mortality from upper GI endoscopic mucosal resection |
title | The influence of procedural volume and proficiency gain on mortality from upper GI endoscopic mucosal resection |
title_full | The influence of procedural volume and proficiency gain on mortality from upper GI endoscopic mucosal resection |
title_fullStr | The influence of procedural volume and proficiency gain on mortality from upper GI endoscopic mucosal resection |
title_full_unstemmed | The influence of procedural volume and proficiency gain on mortality from upper GI endoscopic mucosal resection |
title_short | The influence of procedural volume and proficiency gain on mortality from upper GI endoscopic mucosal resection |
title_sort | influence of procedural volume and proficiency gain on mortality from upper gi endoscopic mucosal resection |
topic | Endoscopy |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5754854/ https://www.ncbi.nlm.nih.gov/pubmed/27797934 http://dx.doi.org/10.1136/gutjnl-2015-311237 |
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