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Analysis of the learning process for laparoscopic sleeve gastrectomy: CUSUM-curve of 110 consecutive patients with 1-year follow-up - 21/05/20

Doi : 10.1016/j.jviscsurg.2020.05.001 
G. Fantola a, M. Agus a, , M. Runfola a, F. Rebecchi b, C. Podda c, R. Moroni a
a Chirurgia dell’Obesità, Azienda Ospedaliera Brotzu, Piazzale Alessandro Ricchi, 1, 09134 Cagliari, Italy 
b Dipartimento di Scienze Chirurgiche, Università degli Studi di Torino, Corso Dogliotti 14, Torino, Italy 
c Department of Life and Environmental Science, University of Cagliari, Via Ospedale 72, Cagliari, Italy 

Corresponding author at: Via Raffaello 8, 09012 Capoterra, Cagliari, Italy.Via Raffaello 8Capoterra, Cagliari09012Italy
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le jeudi 21 mai 2020

Summary

Introduction

Laparoscopic sleeve gastrectomy (LSG) is the most popular bariatric procedure worldwide. A tremendous recent increase in the number of LSGs has not been driven by an accurate learning process, especially in low volume bariatric centers. The cumulative-sum (CUSUM) method is an effective analysis of the learning process, taking intraoperative and postoperative variables into account. This study was aimed at establishing a CUSUM learning curve for LSG in order to define the number of procedures needed to achieve sufficient surgical skill.

Methods

All LSGs performed by a single general surgeon between September 2014 and November 2017 were considered. We hypothesized that the key t variables related to the LSG learning process (LP) are: operative time (OT), intraoperative complications or difficulties, need for expert assistance, length of hospital stay (LOS), and 3-month postoperative morbidity. All of these parameters are binary variables analyzed with the risk-adjusted CUSUM method. Two groups, learning group (LG) and experienced group (EG), were identified and compared by univariate analysis. Multivariate analysis was performed to identify the variables most closely associated with operative time and surgical success. One-year weight loss outcomes were likewise analyzed.

Results

One hundred and ten (110) consecutive LSGs were considered. CUSUM-LSG showed that the mean number of consecutive interventions necessary to reach proficiency in LSG was 58. In multivariate analysis, surgical success was negatively correlated with longer operative time and need for expert assistance. Body mass index was not correlated with surgical success.

Conclusion

Fifty-eight LSG procedures were required to achieve surgical skill. Operative time and the need for expert assistance were variables most closely associated with surgical success.

ACGME competency

Practice-based learning and improvement.

Le texte complet de cet article est disponible en PDF.

Keywords : Laparoscopic sleeve gastrectomy, Learning process, Bariatric surgery, CUSUM-curve, Operative time


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