A skill degradation in laparoscopic surgery after a long absence: assessment based on nephrectomy case

Abstract

Aim: To examine the laparoscopic skill-degradation effect by investigating whether a long absence from laparoscopic surgery increases laparoscopic surgery time.

Methods: Using the Japanese Diagnosis Procedure Combination database from April 2010 to March 2012, data for patients undergoing laparoscopic nephrectomy and nephroureterectomy for malignancy were collected. To regulate the hospital volume effect, the hospitals included in the study were limited to those with hospital volumes of 12-24 per year. Laparoscopic time was assessed by multivariate linear regression analysis including interval days, age, gender, comorbidity, oncological stage, nephrectomy or nephroureterectomy, hospital academic status, and hospital volume.

Results: For intervals of ≥ 7 days (3057 cases), 8-14 days (1325 cases), 15-28 days (1424 cases), 29-56 days (711 cases), and ≤ 57 days (332 cases), the median laparoscopic times were 245, 247, 255, 265, and 260 min, respectively (P < 0.001). In multivariate analyses for laparoscopic time compared with interval of ≥ 7 days, 15-28 days, 29-56 days and ≤ 57 days were associated with slightly longer laparoscopic time (+10.5, +16.8, and +18.8 min, all P < 0.01, respectively).

Conclusion: Absence intervals of ≤ 15 days can slightly lengthen the operation time, which suggest the existence of mild degree of a skill-degradation effect in laparoscopic surgery.

Keywords

Clinical competence / laparoscopic nephrectomy / laparoscopic nephroureterectomy / learning curve / skill retention

References

[1] Finks JF,Birkmeyer JD.Trends in hospital volume and operative mortality for high-risk surgery..N Engl J Med2011;364:2128-37 PMCID:PMC3150488

[2] Higashihara E,Nakagawa K,Go H,Takahashi K,Fujita K,Ohshima S,Terachi T.Learning curve and conversion to open surgery in cases of laparoscopic adrenalectomy and nephrectomy..J Urol1998;159:650-3

[3] Hamada T,Nakai Y,Matsui H,Koike K.No weekend effect on outcomes of severe acute pancreatitis in Japan: data from the diagnosis procedure combination database..J Gastroenterol2016;51:1063-72

[4] Sugihara T,Horiguchi H,Fujimura T,Fukuhara H,Changhong Y,Fushimi K.Robot-assisted versus other types of radical prostatectomy: population-based safety and cost comparison in Japan, 2012-2013..Cancer Sci2014;105:1421-6 PMCID:PMC4462377

[5] Ravi B,Austin PC,Wasserstein D,Paterson JM,Hawker GA.Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study..BMJ2014;348:g3284 PMCID:PMC4032026

[6] Marrie RA,Garland A.Quantile regression and restricted cubic splines are useful for exploring relationships between continuous variables..J Clin Epidemiol2009;62:511-7.e1

[7] Quan H,Halfon P,Burnand B,Saunders LD,Feasby TE.Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data..Med Care2005;43:1130-9

[8] Sobin LH.TNM Classification of Malignant Tumours, 6th edition..2002;New YorkWiley PMCID:PMC122590

[9] Panageas KS,Riedel E,Begg CB.The effect of clustering of outcomes on the association of procedure volume and surgical outcomes..Ann Intern Med2003;139:658-65

[10] Rubin DB.Multiple imputation in health-care databases: an overview and some applications..Stat Med1991;10:585-98

[11] Harrell FE Jr. rms: Regression Modeling Strategies. Available from: http://CRAN.R-project.org/package=rms [Last accessed on 4 May 2018].

[12] The R Foundation. The R Project for Statistical Computing. Available from: http://www.R-project.org/ [Last accessed on 4 May 2018].

[13] Pusic MV,Szyld D,Pecaric M.Experience curves as an organizing framework for deliberate practice in emergency medicine learning..Acad Emerg Med2012;19:1476-80

[14] Murre JM.Replication and analysis of Ebbinghaus' forgetting curve..PLoS One2015;10:e0120644 PMCID:PMC4492928

[15] Hunter I,Balasubramanian P,Hardman JG.Retention of laryngoscopy skills in medical students: a randomised, cross-over study of the Macintosh, A.P. Advance(™), C-MAC(®) and Airtraq(®) laryngoscopes..Anaesthesia2016;71:1191-7

[16] Atkinson RC.Human memory: a proposed system and its control processes, vol 2..Psychology of learning and motivation.1968;New YorkAcademic Press

[17] Schneider CL,Carbonell AM,Flanagan WF.A collaborative approach reduces the learning curve and improves outcomes in laparoscopic nephrectomy..Surg Endosc2011;25:182-5

[18] Shariff U,Haray PN,Balasubramanian SP.Multimedia educational tools for cognitive surgical skill acquisition in open and laparoscopic colorectal surgery: a randomized controlled trial..Colorectal Dis2015;17:441-50