Learning Curves of Ivor Lewis Totally Minimally Invasive Esophagectomy by Hospital and Surgeon Characteristics: A Retrospective Multi-National Cohort Study.

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To describe the pooled learning curves of Ivor Lewis TMIE in hospitals stratified by predefined hospital and surgeon related factors.Ivor Lewis totally minimally invasive esophagectomy (TMIE) is known to have a long learning curve which is associated with considerable learning associated morbidity. It is unknown whether hospital and surgeon characteristics are associated with more efficient learning.A retrospective analysis of prospectively collected data of consecutive Ivor Lewis TMIE patients in 14 European hospitals was performed. Outcome parameters used as proxy for efficient learning were learning curve length, learning associated morbidity and the plateau level regarding anastomotic leakage and textbook outcome. Pooled incidences were plotted for the factor-based subgroups using generalized additive models and two-phase models. Casemix predicted outcomes were plotted and compared with observed outcomes. The investigated factors included annual volume, (TMIE) experience, clinic visits, courses and fellowships followed, and proctor supervision.This study included 2121 patients. The length of the learning curve was shorter for centers with an annual volume ≥50 compared to centers with an annual volume

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Authors: Linda Claassen, Gerjon Hannink, Misha D P Luyer, Alan P Ainsworth, Mark I van Berge Henegouwen, Edward Cheong, Freek Daams, Marc J van Det, Peter van Duijvendijk, Suzanne S Gisbertz, Christian A Gutschow, Joos Heisterkamp, Juha T Kauppi, Bastiaan R Klarenbeek, Ewout A Kouwenhoven, Barbara S Langenhoff, Michael H Larsen, Ingrid S Martijnse, Ernst Jan van Nieuwenhoven, Donald L van der Peet, Jean-Pierre E N Pierie, Robert E G J M Pierik, Fatih Polat, Jari V Räsänen, Ioannis Rouvelas, Meindert N Sosef, Eelco B Wassenaar, Frits J H van den Wildenberg, Edwin S van der Zaag, Magnus Nilsson, Grard A P Nieuwenhuijzen, Frans van Workum, Camiel Rosman, esophagectomy learning curve collaborative group