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01-02-2021 | Appendectomy | Original Article

Laparoscopic appendectomy as an index procedure for surgical trainees: clinical outcomes and learning curve

Authors: Alessandro Ussia, Samuele Vaccari, Gaetano Gallo, Ugo Grossi, Riccardo Ussia, Lodovico Sartarelli, Margherita Minghetti, Augusto Lauro, Paolo Barbieri, S. Di Saverio, Maurizio Cervellera, Valeria Tonini

Published in: Updates in Surgery | Issue 1/2021

Abstract

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.

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Title: Laparoscopic appendectomy as an index procedure for surgical trainees: clinical outcomes and learning curve
Authors: Alessandro Ussia
Samuele Vaccari
Gaetano Gallo
Ugo Grossi
Riccardo Ussia
Lodovico Sartarelli
Margherita Minghetti
Augusto Lauro
Paolo Barbieri
S. Di Saverio
Maurizio Cervellera
Valeria Tonini
Publication date: 01-02-2021
Publisher: Springer International Publishing
Keyword: Appendectomy
Published in: Updates in Surgery / Issue 1/2021
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-020-00950-z

At a glance: The STEP trials

Springer Medicine

Laparoscopic appendectomy as an index procedure for surgical trainees: clinical outcomes and learning curve

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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