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Surgical Endoscopy
Published in: Surgical Endoscopy 6/2020

Open Access 01-06-2020 | Esophageal Cancer | 2018 EAES Oral

The effect of time between procedures upon the proficiency gain period for minimally invasive esophagectomy

Authors: Sheraz R. Markar, Melody Ni, Hugh Mackenzie, Marta Penna, Omar Faiz, George B. Hanna

Published in: Surgical Endoscopy | Issue 6/2020

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Abstract

Background

Complex surgical procedures including minimally invasive esophagectomy (MIE) are commonly associated with a period of proficiency gain. We aim to study the effect of reduced procedural interval upon the number of cases required to gain proficiency and adverse patient outcomes during this period from MIE.

Methods

All adult patients undergoing MIE for esophageal cancer in England from 2002 to 2012 were identified from Hospital Episode Statistics database. Outcomes evaluated included conversion rate from MIE to open esophagectomy, 30-day re-intervention, 30-day and 90-day mortality. Regression models investigated relationships between procedural interval and the number of cases and clinical outcomes during proficiency gain period.

Results

The MIE dataset comprised of 1696 patents in total, with procedures carried out by 148 surgeons. Thresholds for procedural interval extracted from change-point modeling were found to be 60 days for conversion, 80 days for 30-day re-intervention, 80 days for 30-day mortality and 110 days for 90-day mortality. Procedural interval of MIEs did not influence the number of cases required for proficiency gain. However, reduced MIE procedural interval was associated with significant reductions in conversions (0.16 vs. 0.07; P < 0.001), re-interventions (0.15 vs. 0.09; P < 0.01), 30-day (0.12 vs. 0.05; P < 0.01) and 90-day (0.14 vs. 0.06; P < 0.01) mortality during the period of proficiency gain.

Conclusions

This national study has demonstrated that the introduction of MIE is associated with a period of proficiency gain and adverse patient outcomes. The absolute effect of this period of proficiency gain upon patient morbidity and mortality may be reduced by reduced procedural interval of MIE practice within specialized esophageal cancer centers.
Appendix
Available only for authorised users
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Metadata
Title
The effect of time between procedures upon the proficiency gain period for minimally invasive esophagectomy
Authors
Sheraz R. Markar
Melody Ni
Hugh Mackenzie
Marta Penna
Omar Faiz
George B. Hanna
Publication date
01-06-2020
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 6/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-06692-3

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