Abstract
Background
The learning curve of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery has been well investigated. The learning curve is defined by complications and/or by duration of surgery (DOS). Previous studies report an inverse relationship between patient outcome and patient volume. In this study, we investigate whether the learning curve of preceding bariatric surgeons is of additional influence for surgeons who start to perform LRYGB in the same centre.
Materials and Methods
We retrospectively analysed the records of all 713 consecutive primary LRYGB patients operated in our centre from December 2007 until July 2012. Surgeon 1 and 3 had previous laparoscopic bariatric experience whilst Surgeon 2 and 4 had not. We stratified the data between the four surgeons with different levels of experience and in a chronology of 50 cases.
Results
Sixty-seven (9.4 %) complications occurred in the study period. Surgeon 1 had more complications occurring within the first 50 cases than Surgeon 4 (10 versus 1, p < 0.05). There was no difference in complication rate between groups of 50 consecutive cases. None of the patients died. DOS decreased for every consecutive surgeon, irrespective of their experience. The learning curve defined by DOS was steepest for Surgeon 1, followed by Surgeon 2, 3 and 4.
Conclusion
In this study, we show that the learning curve of the preceding surgeon positively influences the learning curve of latter surgeons, irrespective of their experience. Therefore, the ‘preceding surgeon factor’ should be taken in account in addition to volume requirements when starting new bariatric facilities.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Sturm R, Hattori A. Morbid obesity rates continue to rise rapidly in the United States. Int. J. Obes. (Lond). [Internet]. Nature Publishing Group; 2012 [cited 2013 Jan 22];1–3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22986681.
Sjöstrom L, Lindroos AK, Petlonen M, et al. New Engl J Med. 2004;351:2683–93.
Gonzalez R, Nelson LG, Murr MM. Does establishing a bariatric surgery fellowship training program influence operative outcomes? Surg Endosc [Internet]. 2006;21:109–14. doi:10.1007/s00464-005-0860-8.
Suter M, Giusti V, Héraief E, et al. Laparoscopic Roux-en-Y gastric bypass: initial 2-year experience. Arch Surg [Internet]. 2003;17:603–9. http://www.ncbi.nlm.nih.gov/pubmed/12582767.
Breaux JA, Kennedy CI, Richardson WS. Advanced laparoscopic skills decrease the learning curve for laparoscopic Roux-en-Y gastric bypass. Surg Endosc [Internet]. 2007;21:985–8. http://www.ncbi.nlm.nih.gov/pubmed/17623252.
Buchwald H, Scopinaro N. Retiring the learning curve. Obes Surg [Internet]. 2009;19:541–2. doi:10.1007/s11695-009-9833-7.
Deyo R, Cherkin D, Ciol M. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–9.
DeMaria EJ, Murr M, Byrne TK, et al. Validation of the obesity surgery mortality risk score in a multicenter study proves it stratifies mortality risk in patients undergoing gastric bypass for morbid obesity. Ann Surg [Internet]. 2007;246:578–84. http://www.ncbi.nlm.nih.gov/pubmed/17893494.
Sarela AI, Dexter SPL, McMahon MJ. Use of the obesity surgery mortality risk score to predict complications of laparoscopic bariatric surgery. Obes Surg [Internet]. 2011;21:1698–703. doi:10.1007/s11695-011-0379-0.
Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg [Internet]. 2009;250:187–96. http://www.ncbi.nlm.nih.gov/pubmed/19638912.
Dindo D, Demartines N, Clavien P-A. Classification of surgical complications. Ann Surg [Internet]. 2004;240:205–13. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00000658-200408000-00003.
White PF, Kehlet H, Neal JM, et al. The role of the anesthesiologist in fast-track surgery: from multimodal analgesia to perioperative medical care. Anesth Analg [Internet]. 2007;104:1380–96. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00000539-200706000-00013.
Courcoulas A, Schuchert M, Gatti G, et al. The relationship of surgeon and hospital volume to outcome after gastric bypass surgery in Pennsylvania: a 3-year summary. Surgery [Internet]. 2003;134:613–21. http://linkinghub.elsevier.com/retrieve/pii/S0039606003003064.
Nguyen NT, Paya M, Stevens CM, et al. The relationship between hospital volume and outcome in bariatric surgery at academic medical centers. Ann Surg [Internet]. 2004;240:184–92. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00153307-200401220-00020.
Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg [Internet]. 2004;199:543–51. http://www.ncbi.nlm.nih.gov/pubmed/15454136.
Flum DR, Salem L, Elrod JAB, et al. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA [Internet]. 2005;294:1903–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16234496.
Murr MM, Martin T, Haines K, et al. A state-wide review of contemporary outcomes of gastric bypass in Florida: does provider volume impact outcomes? Ann Surg [Internet]. 2007;245:699–706. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1877059&tool=pmcentrez&rendertype=abstract.
Schauer P, Ikramuddin S, Hamad G, et al. The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc [Internet]. 2003;17:212–5. http://www.ncbi.nlm.nih.gov/pubmed/12457218.
Shikora SA, Kim JJ, Tarnoff ME, et al. Laparoscopic Roux-en-Y gastric bypass. Arch Surg. 2005;140:362–7.
Sánchez-Santos R, Estévez S, Tomé C, et al. Training programs influence in the learning curve of laparoscopic gastric bypass for morbid obesity: a systematic review. Obes Surg [Internet]. 2012;22:34–41. doi:10.1007/s11695-011-0398-x. Springer-Verlag.
Søvik TT, Aasheim ET, Kristinsson J, et al. Establishing laparoscopic Roux-en-Y gastric bypass: perioperative outcome and characteristics of the learning curve. Obes Surg [Internet]. 2008;19:158–65. doi:10.1007/s11695-008-9584-x.
Iordens GIT, Klaassen RA, van Lieshout EMM, et al. How to train surgical residents to perform laparoscopic Roux-en-Y gastric bypass safely. World J Surg [Internet]. 2012;36:2003–10. http://www.ncbi.nlm.nih.gov/pubmed/22576184.
Ballantyne GH, Ewing D, Capella RF, et al. The learning curve measured by operating times for laparoscopic and open gastric bypass: roles of surgeon’s experience, institutional experience, body mass index and fellowship training. Obes Surg. 2005;15:172–82.
COEMBS Designation Requirements [Internet]. Available from: http://www.surgicalreview.org/wp-content/uploads/COEMBS-Requirements_Rev-02-2013.pdf.
Acknowledgments
The authors would like to acknowledge Dr. D. Moes, Dr. B. van den Heuvel and Dr. I. Kappers for their contribution in providing data and feedback for this paper.
Grant Information
None of the authors have received grants or any other kind of financial support to declare.
Conflict of Interest
The authors declare that they have no conflict of interest.
Statement of Informed Consent
Prior to surgery, an informed consent form is filled in by all patients that receive surgery in the Slotervaart Hospital. All patients agreed to the usage of their data in an anonymous form.
Statement of Human and Animal Rights
Due to the retrospective nature of this study, formal consent is not required and has been waived by the hospital’s Medical Ethics Committee.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Geubbels, N., de Brauw, L.M., Acherman, Y.I.Z. et al. The Preceding Surgeon Factor in Bariatric Surgery: a Positive Influence on the Learning Curve of Subsequent Surgeons. OBES SURG 25, 1417–1424 (2015). https://doi.org/10.1007/s11695-014-1538-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-014-1538-x