Laparoscopic appendectomy as an index procedure for surgical trainees: clinical outcomes and learning curve.
CUSUM analysis
Clinical outcomes
Laparoscopic appendectomy
Learning curve
Surgical Training
Trainees
Journal
Updates in surgery
ISSN: 2038-3312
Titre abrégé: Updates Surg
Pays: Italy
ID NLM: 101539818
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
accepted:
11
12
2020
pubmed:
6
1
2021
medline:
4
8
2021
entrez:
5
1
2021
Statut:
ppublish
Résumé
Surgical training is essential to maintain safety standards in healthcare. The aim of this study is to evaluate learning curves and short-term postoperative outcomes of laparoscopic appendectomy (LA) performed by trainees (TRN) and attendings (ATT). The present study included the medical records of patients with acute appendicitis who underwent a fully LA in our department between January 2013 and December 2018. Cases were divided into trainees (TRN and ATT groups based on the experience of the operating surgeon. The primary outcome measures were 30-day morbidity and mortality. Preoperative patients' clinical characteristics, intraoperative findings, operative times, and postoperative hospitalization were compared. Operative times were used to extrapolate learning curves and evaluate the effects of changes in faculty using CUSUM charts. A propensity score matching analysis was performed to reduce differences between cohorts regarding both preoperative characteristics and intraoperative findings. A total of 1173 patients undergoing LA for acute appendicitis were included, of whom 521 (45%) in the TRN group and 652 (55%) in the ATT group. No significant differences were found between the two groups in terms of complication rates, operative times and length of hospital stay. However, CUSUM chart analysis showed decreased operating times in the TRN group. Operative times improved more quickly for advanced cases. The results of this study indicate that LA can be performed by trainees without detrimental effects on clinical outcomes, procedural safety, and operative times. However, the learning curve is longer than previously acknowledged.
Identifiants
pubmed: 33398773
doi: 10.1007/s13304-020-00950-z
pii: 10.1007/s13304-020-00950-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
187-195Références
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