Faculty Collaboration Database

The learning curve in pancreatic surgery. Surgery 2007 May;141(5):694-701

Date

05/22/2007

Pubmed ID

17511115

DOI

10.1016/j.surg.2007.04.001

Scopus ID

2-s2.0-34247199368 (requires institutional sign-in at Scopus site)   125 Citations

Abstract

BACKGROUND: Pancreatic surgery is technically complex. We hypothesized that a learning curve existed for pancreaticoduodenectomy even for surgeons who had completed their training.

METHODS: During 1990 to 2004, we studied 650 consecutive patients who underwent pancreaticoduodenectomy by 3 surgeons who began their attending careers at 1 center. Operative time, estimated blood loss (EBL), length of hospital stay (LOS), and the status of resection margins (for pancreatic adenocarcinoma) were analyzed. The chi2, independent t test and Mann-Whitney U test were used to evaluate differences in categorical, normally distributed continuous, and non-normally distributed continuous variables, respectively. Using serial groups of 30 cases, median operative time, EBL, and LOS were calculated and the trend over time modeled using third-order polynomial equations. Trends in retroperitoneal margin positivity (R0/R1) were assessed.

RESULTS: From the first 60 cases per surgeon to the second 60 cases per surgeon, the median EBL dropped (1100 vs 725 mL, P < .001), operative time decreased (589 vs 513 minutes, P < .001), and LOS decreased (15 vs 13 days, P = .004). The proportion of microscopically positive or suspicious margins also decreased from the surgeons' first 60 cases each to the second 60 cases (30% vs 8%, P < .001). Extended analysis of a single surgeon's cases suggested that additional experience provided further incremental improvement (P < .001).

CONCLUSIONS: Pancreaticoduodenectomy has an inherent learning curve. After 60 cases, surgeons achieved significantly decreased EBL, operative time, and LOS, and carried out more margin-negative resections. Improvement in measured outcomes continues during the operative career.

Author List

Tseng JF, Pisters PW, Lee JE, Wang H, Gomez HF, Sun CC, Evans DB

Author

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Blood Loss, Surgical
Clinical Competence
Female
General Surgery
Humans
Length of Stay
Male
Middle Aged
Pancreaticoduodenectomy
Retrospective Studies
Time Factors
Treatment Outcome