Predictors of laparoscopic complications after formal training in laparoscopic surgery
W. A. See, C. S. Cooper and R. J. Fisher
Department of Urology, University of Iowa Hospitals and Clinics, Iowa City.
OBJECTIVE--To evaluate the relationship between laparoscopic complication
rates and surgeon-dependent variables following a laparoscopic training
course. DESIGN--Participants were surveyed regarding their interval
laparoscopic experience 3 months and 12 months after the course.
PARTICIPANTS--Course participants/survey respondents represented a cross
section of urologic surgeons in the United States. A total of 181
individuals (61% of 297 participants) completed and returned the 3-month
questionnaire. A total of 128 surgeons responded to the 12-month
questionnaire (78.5% of 163 participants). MAIN OUTCOME MEASURE--Logistic
regression analysis tested the relationship between surgeons' complication
rates and study variables. RESULTS--At 3 months, surgeons who performed
clinical procedures without additional training were 3.39 times more likely
to have at least one complication compared with surgeons who sought
additional training (P = .03). At 12 months, surgeons who had attended the
training course alone, were in solo practice, or performed laparoscopic
surgery with a variable assistant were 4.85, 7.74, and 4.80 times more
likely, respectively, to have had a complication than their counterparts
who attended the course with a partner, were in group practice, or operated
with the same assistant (P = .004, P = .0008, and P = .0015, respectively).
At both 3 and 12 months, laparoscopic complication rates of individual
surgeons demonstrated a significant inverse correlation with the number of
laparoscopic procedures performed. CONCLUSIONS--The rate of complications
associated with the clinical learning curve can be decreased by additional
education following an initial course in laparoscopy. An ongoing clinical
association with surgeons performing similar procedures decreases long-term
complication rates.
