Laparoscopic Colorectal Surgery Outcomes Improved After National Training Program (LAPCO) for Specialists in England.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 06 2022
01 06 2022
Historique:
pubmed:
22
10
2020
medline:
1
6
2022
entrez:
21
10
2020
Statut:
ppublish
Résumé
To examine the impact of The National Training Program for Lapco on the rate of laparoscopic surgery and clinical outcomes of cases performed by Lapco surgeons after completion of training. Lapco provided competency-based supervised clinical training for specialist colorectal surgeons in England. We compared the rate of laparoscopic surgery, mortality, and morbidity for colorectal cancer resections by Lapco delegates and non-Lapco surgeons in 3-year periods preceding and following Lapco using difference in differences analysis. The changes in the rate of post-Lapco laparoscopic surgery with the Lapco sign-off competency assessment and in-training global assessment scores were examined using risk-adjusted cumulative sum to determine their predictive clinical validity with predefined competent scores of 3 and 5 respectively. One hundred eight Lapco delegates performed 4586 elective colo-rectal resections pre-Lapco and 5115 post-Lapco while non-Lapco surgeons performed 72,930 matched cases. Lapco delegates had a 37.8% increase in laparoscopic surgery which was greater than non-Lapco surgeons by 20.9% [95% confidence interval (CI), 18.5-23.3, P < 0.001) with a relative decrease in 30-day mortality by -1.6% (95% CI, -3.4 to -0.2, P = 0.039) and 90-day mortality by -2.3% (95% CI, -4.3 to -0.4, P = 0.018). The change point of risk-adjusted cumulative sum was 3.12 for competency assessment tool and 4.74 for global assessment score whereas laparoscopic rate increased from 44% to 66% and 40% to 56%, respectively. Lapco increased the rate of laparoscopic colorectal cancer surgery and reduced mortality and morbidity in England. In-training competency assessment tools predicted clinical performance after training.
Sections du résumé
OBJECTIVE
To examine the impact of The National Training Program for Lapco on the rate of laparoscopic surgery and clinical outcomes of cases performed by Lapco surgeons after completion of training.
SUMMARY OF BACKGROUND DATA
Lapco provided competency-based supervised clinical training for specialist colorectal surgeons in England.
METHODS
We compared the rate of laparoscopic surgery, mortality, and morbidity for colorectal cancer resections by Lapco delegates and non-Lapco surgeons in 3-year periods preceding and following Lapco using difference in differences analysis. The changes in the rate of post-Lapco laparoscopic surgery with the Lapco sign-off competency assessment and in-training global assessment scores were examined using risk-adjusted cumulative sum to determine their predictive clinical validity with predefined competent scores of 3 and 5 respectively.
RESULTS
One hundred eight Lapco delegates performed 4586 elective colo-rectal resections pre-Lapco and 5115 post-Lapco while non-Lapco surgeons performed 72,930 matched cases. Lapco delegates had a 37.8% increase in laparoscopic surgery which was greater than non-Lapco surgeons by 20.9% [95% confidence interval (CI), 18.5-23.3, P < 0.001) with a relative decrease in 30-day mortality by -1.6% (95% CI, -3.4 to -0.2, P = 0.039) and 90-day mortality by -2.3% (95% CI, -4.3 to -0.4, P = 0.018). The change point of risk-adjusted cumulative sum was 3.12 for competency assessment tool and 4.74 for global assessment score whereas laparoscopic rate increased from 44% to 66% and 40% to 56%, respectively.
CONCLUSIONS
Lapco increased the rate of laparoscopic colorectal cancer surgery and reduced mortality and morbidity in England. In-training competency assessment tools predicted clinical performance after training.
Identifiants
pubmed: 33086313
pii: 00000658-202206000-00019
doi: 10.1097/SLA.0000000000004584
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1149-1155Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Miskovic D, Ni M, Wyles SM, et al. Learning curve and case selection in laparoscopic colorectal surgery: systematic review and international multi-center analysis of 4852 cases. Dis Colon Rectum 2012; 55:1300–1310.
Mackenzie H, Markar SR, Askari A, et al. National proficiency-gain curves for minimally invasive gastrointestinal cancer surgery. Br J Surg 2016; 103:88–96.
Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 2005; 365:1718–1726.
Group COoSTS. A comparison of laparoscopically assisted and open colec-tomy for colon cancer. N Engl J Med 2004; 350:2050–2059.
Buunen M, Veldkamp R, Hop WC, et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 2009; 10:44–52.
Jayne DG, Thorpe HC, Copeland J, et al. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 2010; 97:1638–1645.
Prakash K, Kamalesh NP, Pramil K, et al. Does case selection and outcome following laparoscopic colorectal resection change after initial learning curve? Analysis of 235 consecutive elective laparoscopic colorectal resections. J Minim Access Surg 2013; 9:99–103.
Miskovic D, Wyles SM, Carter F, et al. Development, validation and implementation of a monitoring tool for training in laparoscopic colorectal surgery in the English National Training Program. Surg Endosc 2011; 25:1136–1142.
Miskovic D, Ni M, Wyles SM, et al. Is competency assessment at the specialist level achievable? A study for the national training programme in laparoscopic colorectal surgery in England. Ann Surg 2013; 257:476–482.
Mackenzie H, Ni M, Miskovic D, et al. Clinical validity of consultant technical skills assessment in the English National Training Programme for Laparoscopic Colorectal Surgery. Br J Surg 2015; 102:991–997.
Mackenzie H, Cuming T, Miskovic D, et al. Design, delivery, andvalidationof a trainer curriculum for the national laparoscopic colorectal training program in England. Ann Surg 2015; 261:149–156.
Wyles SM, Miskovic D, Ni Z, et al. Development and implementation of the Structured Training Trainer Assessment Report (STTAR) in the English National Training Programme for laparoscopic colorectal surgery. Surg Endosc 2016; 30:993–1003.
Askari A, Nachiappan S, Currie A, et al. Selection for laparoscopic resection confers a survival benefit in colorectal cancer surgery in England. Surg Endosc 2016; 30:3839–3847.
Kirkpatrick JD. Evaluating Training Programs. 3rd ed. San Francisco, CA: Berret-Koehler Publ; 2006.
Barkun JS, Aronson JK, Feldman LS, et al. Evaluation and stages of surgical; innovations. Lancet 2009; 374:1089–1096.
Birkmeyer JD, Finks JF, O’Reilly, et al. Surgical skill and complication rates after bariatric surgery. N Engl J Med 2013; 369:1434–1442.
Ward ST, Hancox A, Mohammed MA, et al. The learning curve to achieve satisfactory completion rates in upper GI endoscopy: an analysis of a national training database. Gut 2017; 66:1022–1033.
Siau K, Anderson JT, Valori R, et al. Certification of UK gastrointestinal endoscopists and variations between specialties: results from the JET e-portfolio. Endosc Int Open 2019; 7:E551–E560.
Aylin P, Alves B, Best N, et al. Comparison of UK paediatric cardiac surgical performance by analysis of routinely collected data 1984-96: was Bristol an outlier? Lancet 2001; 358:181–187.