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The effect of time between procedures upon the proficiency gain period for minimally invasive esophagectomy
BACKGROUND: Complex surgical procedures including minimally invasive esophagectomy (MIE) are commonly associated with a period of proficiency gain. We aim to study the effect of reduced procedural interval upon the number of cases required to gain proficiency and adverse patient outcomes during this...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7214481/ https://www.ncbi.nlm.nih.gov/pubmed/32314077 http://dx.doi.org/10.1007/s00464-019-06692-3 |
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author | Markar, Sheraz R. Ni, Melody Mackenzie, Hugh Penna, Marta Faiz, Omar Hanna, George B. |
author_facet | Markar, Sheraz R. Ni, Melody Mackenzie, Hugh Penna, Marta Faiz, Omar Hanna, George B. |
author_sort | Markar, Sheraz R. |
collection | PubMed |
description | BACKGROUND: Complex surgical procedures including minimally invasive esophagectomy (MIE) are commonly associated with a period of proficiency gain. We aim to study the effect of reduced procedural interval upon the number of cases required to gain proficiency and adverse patient outcomes during this period from MIE. METHODS: All adult patients undergoing MIE for esophageal cancer in England from 2002 to 2012 were identified from Hospital Episode Statistics database. Outcomes evaluated included conversion rate from MIE to open esophagectomy, 30-day re-intervention, 30-day and 90-day mortality. Regression models investigated relationships between procedural interval and the number of cases and clinical outcomes during proficiency gain period. RESULTS: The MIE dataset comprised of 1696 patents in total, with procedures carried out by 148 surgeons. Thresholds for procedural interval extracted from change-point modeling were found to be 60 days for conversion, 80 days for 30-day re-intervention, 80 days for 30-day mortality and 110 days for 90-day mortality. Procedural interval of MIEs did not influence the number of cases required for proficiency gain. However, reduced MIE procedural interval was associated with significant reductions in conversions (0.16 vs. 0.07; P < 0.001), re-interventions (0.15 vs. 0.09; P < 0.01), 30-day (0.12 vs. 0.05; P < 0.01) and 90-day (0.14 vs. 0.06; P < 0.01) mortality during the period of proficiency gain. CONCLUSIONS: This national study has demonstrated that the introduction of MIE is associated with a period of proficiency gain and adverse patient outcomes. The absolute effect of this period of proficiency gain upon patient morbidity and mortality may be reduced by reduced procedural interval of MIE practice within specialized esophageal cancer centers. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00464-019-06692-3) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-7214481 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-72144812020-05-14 The effect of time between procedures upon the proficiency gain period for minimally invasive esophagectomy Markar, Sheraz R. Ni, Melody Mackenzie, Hugh Penna, Marta Faiz, Omar Hanna, George B. Surg Endosc 2018 EAES Oral BACKGROUND: Complex surgical procedures including minimally invasive esophagectomy (MIE) are commonly associated with a period of proficiency gain. We aim to study the effect of reduced procedural interval upon the number of cases required to gain proficiency and adverse patient outcomes during this period from MIE. METHODS: All adult patients undergoing MIE for esophageal cancer in England from 2002 to 2012 were identified from Hospital Episode Statistics database. Outcomes evaluated included conversion rate from MIE to open esophagectomy, 30-day re-intervention, 30-day and 90-day mortality. Regression models investigated relationships between procedural interval and the number of cases and clinical outcomes during proficiency gain period. RESULTS: The MIE dataset comprised of 1696 patents in total, with procedures carried out by 148 surgeons. Thresholds for procedural interval extracted from change-point modeling were found to be 60 days for conversion, 80 days for 30-day re-intervention, 80 days for 30-day mortality and 110 days for 90-day mortality. Procedural interval of MIEs did not influence the number of cases required for proficiency gain. However, reduced MIE procedural interval was associated with significant reductions in conversions (0.16 vs. 0.07; P < 0.001), re-interventions (0.15 vs. 0.09; P < 0.01), 30-day (0.12 vs. 0.05; P < 0.01) and 90-day (0.14 vs. 0.06; P < 0.01) mortality during the period of proficiency gain. CONCLUSIONS: This national study has demonstrated that the introduction of MIE is associated with a period of proficiency gain and adverse patient outcomes. The absolute effect of this period of proficiency gain upon patient morbidity and mortality may be reduced by reduced procedural interval of MIE practice within specialized esophageal cancer centers. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00464-019-06692-3) contains supplementary material, which is available to authorized users. Springer US 2020-04-20 2020 /pmc/articles/PMC7214481/ /pubmed/32314077 http://dx.doi.org/10.1007/s00464-019-06692-3 Text en © The Author(s) 2020 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 | 2018 EAES Oral Markar, Sheraz R. Ni, Melody Mackenzie, Hugh Penna, Marta Faiz, Omar Hanna, George B. The effect of time between procedures upon the proficiency gain period for minimally invasive esophagectomy |
title | The effect of time between procedures upon the proficiency gain period for minimally invasive esophagectomy |
title_full | The effect of time between procedures upon the proficiency gain period for minimally invasive esophagectomy |
title_fullStr | The effect of time between procedures upon the proficiency gain period for minimally invasive esophagectomy |
title_full_unstemmed | The effect of time between procedures upon the proficiency gain period for minimally invasive esophagectomy |
title_short | The effect of time between procedures upon the proficiency gain period for minimally invasive esophagectomy |
title_sort | effect of time between procedures upon the proficiency gain period for minimally invasive esophagectomy |
topic | 2018 EAES Oral |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7214481/ https://www.ncbi.nlm.nih.gov/pubmed/32314077 http://dx.doi.org/10.1007/s00464-019-06692-3 |
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