TITLE

Operative time is a poor surrogate for the learning curve in laparoscopic colorectal surgery

AUTHOR(S)
Chen, W.; Sailhamer, E.; Berger, D.; Rattner, D.; Berger, D L; Rattner, D W
PUB. DATE
February 2007
SOURCE
Surgical Endoscopy;Feb2007, Vol. 21 Issue 2, p238
SOURCE TYPE
Academic Journal
DOC. TYPE
journal article
ABSTRACT
Background: Previous studies have relied on conversion rate and operative time for construction of learning curves in laparoscopic colorectal surgery. The authors hypothesized that conversion rate and operative time were less important than complication and readmission rates in defining good outcomes and hence the learning curve.Methods: A database of 287 consecutive laparoscopic colorectal resections from a single tertiary referral center was analyzed. Outcome measures included operative time, conversion rate, major and minor complications, length of hospital stay, and the 15- and 30-day hospital readmission rate. Data were analyzed both by surgeons and by quartile case numbers.Results: A total of 151 right colectomies and 136 left colectomies were performed between 1995 and 2005. For both right and left colectomies, the conversion rate decreased in each of the first three quartiles, reaching a nadir of 0% for right colectomies and 3% for left colectomies in the third quartile. The conversion rates increased slightly in the fourth quartile. The operative time remained stable for three quartiles, then increased slightly in the fourth quartile. Two surgeons managed 199 of the 287 cases. Analysis of the two high-volume surgeons demonstrated that for left-sided resections, the surgeon with the shorter operative times had the higher major complication rate (13% vs 2%), overall complication rate (22% vs 2%), 30-day readmission rate (13% vs 0%), and length of stay (3.8 vs 3.1 days) (p < 0.05 for all comparisons).Conclusions: In this series, operative time failed to decrease with experience, and shorter operative times did not correlate with better clinical outcomes. The failure of operative time to decline with experience often reflects surgeons' willingness to attempt more difficult cases rather than an accurate representation of a "learning curve." Therefore, complication and readmission rates are more important than operative time and conversion rates for evaluating the learning curve and quality of laparoscopic colorectal surgery.
ACCESSION #
23651524

 

Related Articles

  • Laparoscopic colorectal surgery. Jones, Oliver M.; Lindsey, Ian; Cunningham, Chris // BMJ: British Medical Journal (Overseas & Retired Doctors Edition;1/7/2012, Vol. 344 Issue 7838, p41 

    The article offers information on laparoscopic colorectal surgery, and its similarities on open surgery in terms of effectiveness and in adverse effects. It mentions the benefits of undergoing laparoscopic surgery including pain reduction, minimizing trauma and general mobility. It discusses the...

  • Management of sessile malignant polyps: is colonoscopic polypectomy enough? Wu, Xian-rui; Liang, Jennifer; Church, James; Church, James M // Surgical Endoscopy;Oct2015, Vol. 29 Issue 10, p2947 

    Background: The role of endoscopy in the management of malignant-pedunculated polyps has been well studied, but endoscopic management of malignant sessile polyps has not. Sometimes patients with malignant sessile polyps have comorbidities that make surgery exceptionally risky, and...

  • Conversion in laparoscopic colorectal surgery: Are short-term outcomes worse than with open surgery? Gorgun, E.; Benlice, C.; Abbas, M.; Stocchi, L.; Remzi, F. // Techniques in Coloproctology;Dec2016, Vol. 20 Issue 12, p845 

    Background: The aim of the present study was to compare the perioperative outcomes in patients who underwent planned open colectomy to those who were converted to an open. Methods: All patients who underwent elective colectomy were identified from the American College of Surgeons National...

  • Study Of Non-Biliary Complications Of Laparoscopic Cholecystectomy. Wani, Mumtaz-Ud-Din; Hameed, Shahid; Shahdhar, Muddassir; Wani, Hilal; Mubeen, Basharat; Khan, Sana // Internet Journal of Surgery;2012, Vol. 28 Issue 5, p1 

    Background: Laparoscopic cholecystectomy gained wide acceptance as treatment of choice for cholelithiasis. However, major complications may still account for high morbidity. The most important complications of laparoscopic cholecystectomy are biliary tract injuries. Non-biliary complications can...

  • Hospital tests and patient related factors influencing time-to-theatre in 1000 cases of suspected appendicitis: a cohort study. Beecher, Suzanne; O'Leary, Donal Peter; McLaughlin, Ray // World Journal of Emergency Surgery;2015, Vol. 10 Issue 1, p1 

    Background: Acute appendicitis is increasingly being managed in the setting of a dedicated emergency theatre. However understanding of hospital factors that influence time-to-theatre (TTT) is poor. Thus, the aim of this study is to identify factors that influence TTT and to observe the effect of...

  • Transperitoneal laparoscopic left versus right live donor nephrectomy: Comparison of outcomes. Pandarinath, Shrinivas Rudrapatna; Choudhary, Babulal; Chouhan, Harvinder Singh; Rudramani, Shivashankar; Dubey, Deepak // Indian Journal of Urology;Jul-Sep2014, Vol. 30 Issue 3, p256 

    Introduction: Although laparoscopic donor nephrectomy (LDN) is being performed at many centers, there are reservations on the routine use of laparoscopy for harvesting the right kidney due to a perception of technical complexity and increased incidence of allograft failure, renal vein thrombosis...

  • Enhanced recovery for colorectal surgery: a large NHS trust experience. Fitzgerald, Jocelyn // Gastrointestinal Nursing;Jun2012 Supplement, Vol. 10, p3 

    Following a successful pilot study, an enhanced recovery programme (ERP) was introduced across United Lincolnshire Hospitals NHS Trust for all patients undergoing elective colorectal resections. In this article, Jocelyn Fitzgerald outlines the results of its implementation, which illustrate a...

  • Concurrent Single-Incision Laparoscopic Right Hemicolectomy and Sigmoidectomy for Synchronous Carcinoma: Report of a Case. Hirano, Yasumitsu; Hattori, Masakazu; Sato, Yoshiki; Maeda, Kazuya; Douden, Kenji; Hashizume, Yasuo // Indian Journal of Surgery;Jun2013 Supplement, Vol. 75, p293 

    Synchronous colorectal tumors that require surgical treatments are rare. Preliminary experience with concurrent single-incision laparoscopic right hemicolectomy and sigmoidectomy for synchronous carcinoma is reported. A 61-year-old woman presented to our department for the close examination of a...

  • Single trocar retroperitoneoscopic nephrectomy for unilateral multicystic dysplastic kidney in children. Liem, N.; Dung, L.; Viet, N. // Pediatric Surgery International;Jun2012, Vol. 28 Issue 6, p641 

    The author presents the first report in performing single trocar nephrectomy for five patients with multicystic dysplastic kidney (MCDK). The mean operative time was 66 min and mean postoperative hospital stay was 36 h. There were no perioperative complications. The one-trocar nephrectomy is a...

  • Laparoscopic Transperitoneal Pyelolithotomy for Management of Staghorn Renal Calculi. Nouralizadeh, Akbar; Simforoosh, Nasser; Soltani, Mohammad Hossein; Sarhangnejad, Reza; Ardestanizadeh, Arash; Shabaninia, Shahram; Ziaee, Seyed Amir Mohsen // Journal of Laparoendoscopic & Advanced Surgical Techniques;Jan/Feb2012, Vol. 22 Issue 1, p61 

    Background: Recent developments in laparoscopic and retroperitoneoscopic techniques have modified the treatment of renal and ureteral stones. We present the efficacy and possible adverse complications of laparoscopic pyelolithotomy for the treatment of staghorn stones as an alternative to...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics