TY - JOUR
T1 - The learning curve for laparoscopic cholecystectomy
AU - The Southern Surgeons Club, Southern Surgeons Club
AU - Moore, Michael J.
AU - Bennett, Charles L.
N1 - Funding Information:
From the Department of Economics, The Fuqua School of Business (MJM) and the Center for Health, Policy Research and Education, Duke University Medical Center, and the VA Medical Center, Department of Medicine (CLB), Durham, North Carolina. *Members and associates of the Southern Surgeons Club who contributed to this study and other participants are listed in the Appendix. Grant support: Dr. Bennett is a recipient of a Senior Career Development Award of the Veterans Administration. Presented in part at the National Institutes of Heafth Consensus Development Conference, “Gallstones and Laparoscopic Cholecystectomy,” Bethesda, Maryland, September 14-16, 1992. Requests for reprints should be addressed to William C. Meyers, MD, Chief, Gastrointestinal Surgery, Duke University Medical Center, Durham, North Carolina 27710. Manuscript submitted April 51994 and accepted in revised form August 16, 1994.
PY - 1995
Y1 - 1995
N2 - Background: The use of laparoscopic surgical procedures without previous training has grown rapidly. At the same time, there have been allegations of increased complications among less experienced surgeons. Methods: Using multivariate regression analyses, we evaluated the relationship between bile duct injury rate and experience with laparoscopic cholecystectomy for surgeons in the Southern Surgeons Club. Results: Fifty-five surgeons performed 8,839 procedures. Fifteen bile duct injuries (by 13 surgeons) resulted with 90% of the injuries occurring within the first 30 cases performed by an individual surgeon. Multivariate analyses indicated that the only significant factor associated with an adverse outcome was the surgeon's experience with the procedure. A regression model predicted that a surgeon had a 1.7% chance of a bile duct injury occurring in the first case and a 0.17% chance of a bile duct injury at the 50th case. Conclusions: While surgeons appear to learn this procedure rapidly, institutions might consider requiring surgeons to move beyond the initial learning curve before awarding privileges.
AB - Background: The use of laparoscopic surgical procedures without previous training has grown rapidly. At the same time, there have been allegations of increased complications among less experienced surgeons. Methods: Using multivariate regression analyses, we evaluated the relationship between bile duct injury rate and experience with laparoscopic cholecystectomy for surgeons in the Southern Surgeons Club. Results: Fifty-five surgeons performed 8,839 procedures. Fifteen bile duct injuries (by 13 surgeons) resulted with 90% of the injuries occurring within the first 30 cases performed by an individual surgeon. Multivariate analyses indicated that the only significant factor associated with an adverse outcome was the surgeon's experience with the procedure. A regression model predicted that a surgeon had a 1.7% chance of a bile duct injury occurring in the first case and a 0.17% chance of a bile duct injury at the 50th case. Conclusions: While surgeons appear to learn this procedure rapidly, institutions might consider requiring surgeons to move beyond the initial learning curve before awarding privileges.
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U2 - 10.1016/S0002-9610(99)80252-9
DO - 10.1016/S0002-9610(99)80252-9
M3 - Article
C2 - 7793496
AN - SCOPUS:0029019926
SN - 0002-9610
VL - 170
SP - 55
EP - 59
JO - American journal of surgery
JF - American journal of surgery
IS - 1
ER -