Fellowship training influences learning curves for laparoscopic sleeve gastrectomy.
Bariatric surgery
Fellowship training
Learning curve
Sleeve gastrectomy
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
02 2022
02 2022
Historique:
received:
15
08
2020
accepted:
09
02
2021
pubmed:
24
2
2021
medline:
4
3
2022
entrez:
23
2
2021
Statut:
ppublish
Résumé
Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric surgical procedure. Little is known about how surgeon training background influences the learning curve of this procedure. We examined operating times (OT), weight loss outcomes, and 30-day complications between surgeons with and without fellowship training in LSG. We hypothesize that post-residency training specific to LSG influences learning curves. Surgeons from a single institution were split into two groups: those who had not completed fellowship training in LSG (NF, n = 3), and those who had completed LSG specific training in fellowship (SGF, n = 3). OTs, BMI changes at 1 year, and 30-day readmissions, reoperations, and complications were extracted for the first 100 LSG cases of each surgeon. Data were analyzed in bins of 20 cases. Comparisons were made between cohorts within a bin and between adjacent bins of the same surgeon cohort. Logistic regression analyses were performed of OT and weight loss outcomes. SGF surgeons showed no difference in OTs over their first 100 cases. NF surgeons had statistically significant increased OTs compared to SGF surgeons during their first 60 cases and progressively shortened OTs during that interval (109 min to 78 min, p < 0.001 for NF surgeons vs. 73 min to 69 min, SGF surgeons). NF surgeons had a significantly steeper slope for improvement in OT over case number. There was no correlation between case number and weight loss outcomes in either group, and no differences in 30-day outcomes between groups. Surgeons who trained to perform LSG in fellowship demonstrate faster and consistent OR times on their initial independent LSG cases compared to surgeons who did not, with no correlation between case number and weight loss outcomes or safety profiles for either group. This suggests that learning curves for LSG are achieved during formal case-specific fellowship training.
Sections du résumé
BACKGROUND
Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric surgical procedure. Little is known about how surgeon training background influences the learning curve of this procedure. We examined operating times (OT), weight loss outcomes, and 30-day complications between surgeons with and without fellowship training in LSG. We hypothesize that post-residency training specific to LSG influences learning curves.
METHODS
Surgeons from a single institution were split into two groups: those who had not completed fellowship training in LSG (NF, n = 3), and those who had completed LSG specific training in fellowship (SGF, n = 3). OTs, BMI changes at 1 year, and 30-day readmissions, reoperations, and complications were extracted for the first 100 LSG cases of each surgeon. Data were analyzed in bins of 20 cases. Comparisons were made between cohorts within a bin and between adjacent bins of the same surgeon cohort. Logistic regression analyses were performed of OT and weight loss outcomes.
RESULTS
SGF surgeons showed no difference in OTs over their first 100 cases. NF surgeons had statistically significant increased OTs compared to SGF surgeons during their first 60 cases and progressively shortened OTs during that interval (109 min to 78 min, p < 0.001 for NF surgeons vs. 73 min to 69 min, SGF surgeons). NF surgeons had a significantly steeper slope for improvement in OT over case number. There was no correlation between case number and weight loss outcomes in either group, and no differences in 30-day outcomes between groups.
CONCLUSION
Surgeons who trained to perform LSG in fellowship demonstrate faster and consistent OR times on their initial independent LSG cases compared to surgeons who did not, with no correlation between case number and weight loss outcomes or safety profiles for either group. This suggests that learning curves for LSG are achieved during formal case-specific fellowship training.
Identifiants
pubmed: 33620566
doi: 10.1007/s00464-021-08372-7
pii: 10.1007/s00464-021-08372-7
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1601-1608Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.
Références
Varela JE, Nguyen NT (2015) Laparoscopic sleeve gastrectomy leads the US utilization of bariatric surgery at academic medical centers. Surg Obes Relat Dis 11(5):987–990
doi: 10.1016/j.soard.2015.02.008
Nguyen NT et al (2016) Trends in utilization of bariatric surgery, 2009–2012. Surg Endosc 30(7):2723–2727
doi: 10.1007/s00464-015-4535-9
Peterli R et al (2018) Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA 319(3):255–265
doi: 10.1001/jama.2017.20897
Salminen P et al (2018) Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS randomized clinical trial. JAMA 319(3):241–254
doi: 10.1001/jama.2017.20313
Sucandy I, Antanavicius G (2013) Impact of minimally invasive/bariatric surgery fellowship on perioperative complications and outcomes in the first year of practice. N Am J Med Sci 5(7):419
doi: 10.4103/1947-2714.115785
Varban OA et al (2019) Evaluating the effect of surgical skill on outcomes for laparoscopic sleeve gastrectomy: a video-based study. Ann Surg. https://doi.org/10.1097/SLA.0000000000003385
doi: 10.1097/SLA.0000000000003385
pubmed: 29794842
Gonzalez R, Nelson L, Murr M (2007) Does establishing a bariatric surgery fellowship training program influence operative outcomes? Surg Endosc 21(1):109–114
doi: 10.1007/s00464-005-0860-8
Aminian A et al (2016) A challenge between trainee education and patient safety: does fellow participation impact postoperative outcomes following bariatric surgery? Obes Surg 26(9):1999–2005
doi: 10.1007/s11695-016-2073-8
Kothari SN et al (2005) Training of a minimally invasive bariatric surgeon: are laparoscopic fellowships the answer? Obes Surg 15(3):323–329
doi: 10.1381/0960892053576640
Ballantyne GH et al (2005) The learning curve measured by operating times for laparoscopic and open gastric bypass: roles of surgeon’s experience, institutional experience, body mass index and fellowship training. Obes Surg 15(2):172–182
doi: 10.1381/0960892053268507
Ali MR et al (2010) Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypass. Surg Endosc 24(1):138
doi: 10.1007/s00464-009-0550-z
Carty MJ et al (2009) A detailed analysis of the reduction mammaplasty learning curve: a statistical process model for approaching surgical performance improvement. Plast Reconstr Surg 124(3):706–714
doi: 10.1097/PRS.0b013e3181b17a13
Pernar LI et al (2017) An appraisal of the learning curve in robotic general surgery. Surg Endosc 31(11):4583–4596
doi: 10.1007/s00464-017-5520-2
Harrysson IJ et al (2014) Systematic review of learning curves for minimally invasive abdominal surgery: a review of the methodology of data collection, depiction of outcomes, and statistical analysis. Ann Surg 260:37
doi: 10.1097/SLA.0000000000000596
Macdonald AL, Haddad M, Clarke SA (2016) Learning curves in pediatric minimally invasive surgery: a systematic review of the literature and a framework for reporting. J Laparoendosc Adv Surg Tech 26(8):652–659
doi: 10.1089/lap.2016.0193
Chang L et al (2003) Robotic surgery: identifying the learning curve through objective measurement of skill. Surg Endosc Other Interv Tech 17(11):1744–1748
doi: 10.1007/s00464-003-8813-6
Suguita FY et al (2017) Learning curve takes 65 repetitions of totally extraperitoneal laparoscopy on inguinal hernias for reduction of operating time and complications. Surg Endosc 31(10):3939–3945
doi: 10.1007/s00464-017-5426-z
Hasbahceci M et al (2014) A new proposal for learning curve of TEP inguinal hernia repair: ability to complete operation endoscopically as a first phase of learning curve. Minim Invas Surg 2014:528517
Neumayer LA et al (2005) Proficiency of surgeons in inguinal hernia repair: effect of experience and age. Ann Surg 242(3):344
doi: 10.1097/01.sla.0000179644.02187.ea
Choi YY, Kim Z, Hur KY (2012) Learning curve for laparoscopic totally extraperitoneal repair of inguinal hernia. Can J Surg 55(1):33
doi: 10.1503/cjs.019610
Simons M et al (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Springer, Berlin
doi: 10.1007/s10029-009-0529-7
Scally CP et al (2016) Video ratings of surgical skill and late outcomes of bariatric surgery. JAMA Surg 151(6):e160428–e160428
doi: 10.1001/jamasurg.2016.0428
Varban OA et al (2019) Assessing variation in technique for sleeve gastrectomy based on outcomes of surgeons ranked by safety and efficacy: a video-based study. Surg Endosc 33(3):895–903
doi: 10.1007/s00464-018-6382-y
Doumouras AG et al (2018) Mastery in bariatric surgery: the long-term surgeon learning curve of Roux-en-Y gastric bypass. Ann Surg 267(3):489–494
doi: 10.1097/SLA.0000000000002180
Zevin B, Aggarwal R, Grantcharov TP (2012) Volume-outcome association in bariatric surgery: a systematic review. Ann Surg 256(1):60–71
doi: 10.1097/SLA.0b013e3182554c62
Markar SR et al (2012) The impact of hospital and surgeon volume on clinical outcome following bariatric surgery. Obes Surg 22(7):1126–1134
doi: 10.1007/s11695-012-0639-7
Chiu C-C et al (2012) The relationship between volume and outcome after bariatric surgery: a nationwide study in Taiwan. Obes Surg 22(7):1008–1015
doi: 10.1007/s11695-012-0636-x
Major P et al (2018) Analysis of laparoscopic sleeve gastrectomy learning curve and its influence on procedure safety and perioperative complications. Obes Surg 28(6):1672–1680
doi: 10.1007/s11695-017-3075-x
Daskalakis M et al (2011) Impact of surgeon experience and buttress material on postoperative complications after laparoscopic sleeve gastrectomy. Surg Endosc 25(1):88–97
doi: 10.1007/s00464-010-1136-5
Zacharoulis D et al (2012) Influence of the learning curve on safety and efficiency of laparoscopic sleeve gastrectomy. Obes Surg 22(3):411–415
doi: 10.1007/s11695-011-0436-8
Dey A, Mittal T, Malik VK (2013) Initial experience with laparoscopic sleeve gastrectomy by a novice bariatric team in an established bariatric center—a review of literature and initial results. Obes Surg 23(4):541–547
doi: 10.1007/s11695-012-0797-7
Casella G et al (2016) Learning curve for laparoscopic sleeve gastrectomy: role of training in a high-volume bariatric center. Surg Endosc 30(9):3741–3748
doi: 10.1007/s00464-015-4670-3
Major P et al (2017) Are bariatric operations performed by residents safe and efficient? Surg Obes Relat Dis 13(4):614–621
doi: 10.1016/j.soard.2016.11.017
Sánchez-Santos R et al (2012) Training programs influence in the learning curve of laparoscopic gastric bypass for morbid obesity: a systematic review. Obes Surg 22(1):34–41
doi: 10.1007/s11695-011-0398-x
Birkmeyer JD et al (2013) Surgical skill and complication rates after bariatric surgery. N Engl J Med 369(15):1434–1442
doi: 10.1056/NEJMsa1300625
Xu R et al (2013) The teaming curve: a longitudinal study of the influence of surgical team familiarity on operative time. Ann Surg 258(6):953–957
doi: 10.1097/SLA.0b013e3182864ffe
Demeusy A, Sill A, Averbach A (2018) Current role of staple line reinforcement in 30-day outcomes of primary laparoscopic sleeve gastrectomy: an analysis of MBSAQIP data, 2015–2016 PUF. Surg Obes Relat Dis 14(10):1454–1461
doi: 10.1016/j.soard.2018.06.024
Berger ER et al (2016) The impact of different surgical techniques on outcomes in laparoscopic sleeve gastrectomies: the first report from the metabolic and bariatric surgery accreditation and quality improvement program (MBSAQIP). Ann Surg 264(3):464–473
doi: 10.1097/SLA.0000000000001851