Cumulative sum failure analysis of the learning curve with endovascular abdominal aortic aneurysm repair

Forbes, Thomas L.; DeRose, Guy; Kribs, Stewart; Harris, Kenneth A.

doi:10.1016/s0741-5214(03)00922-4

Cited by 82 publications

(78 citation statements)

References 49 publications

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“…Endovasküler aortik onarım cerrahiye iyi bir alternatif olmakla beraber, öğrenme dönemleri daha yüksek mortalite ve morbititeye sahip işlemlerdir (11,12) . Üçüncü basamak sağlık hizmeti veren kurumumuzda artan oranda uyguladığımız işlemlerin ilk dönem tecrübemiz incelendiğinde hastane içi ölüm oranları-mız tüm grupta %7 iken, acil olgularda %13.3 elektif olgularda ise %5.3 oranlarıyla daha tecrübeli merkezlerin oranlarıyla benzerlik göstermekteydi (3,11,14) .…”

Section: Discussionunclassified

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Early Experience of Thoracic and Abdominal Endovascular Aortic Repair: a Tertiary Single Centre

Arslantaş¹,

Boztosun²,

Öcal³

et al. 2017

Kosuyolu Heart Journal

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Giriş:Retrospektif bu çalışmanın amaçı, endovasküler abdominal aort onarım (EVAR) ve torasik aortik onarım (TEVAR) erken dönem sonuçlarını değerlendirmek ve hastanemizin erken dönem tecrübesini incelemektir. The purpose of this retrospective study was to evaluate the short-term results of endovascular abdominal aortic repair (EVAR) and thoracic aortic repair (TEVAR) and to present an overview of our early experience at our institution.

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Section: Discussionunclassified

“…Endovasküler uygulamalar öğrenme dönemlerinde daha yüksek mortalite ve morbidite ile ilişkili işlemlerdir (11,12) . Ülkemizden yapılan bildiriler sınırlı hasta sayısını veya geniş dönemi kapsamaktadır.…”

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Early Experience of Thoracic and Abdominal Endovascular Aortic Repair: a Tertiary Single Centre

Arslantaş¹,

Boztosun²,

Öcal³

et al. 2017

Kosuyolu Heart Journal

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“…LOBATO et al (23) have shown that 55 endovascular aneurysm repairs were necessary to achieve optimal results ; and that the interval between the procedures was also important, with one case every 10 days being the minimal workload to achieve these success rates. FORBES et al (24) in their analysis suggested that 60 elective endovascular repairs, or 20 with a specific device, are required to obtain optimal initial clinical success.…”

Section: Discussionmentioning

confidence: 99%

“…The initial use of aorto-aortic tube endograft determined early failure of EVAR for distal aortic attachment site complications and device migrations (24). Nevertheless MAY et al (11) in their experience concluded that there are risks inherent in the endograft method rather than iatrogenic complications that occur as a learning curve phenomenon : new devices have modified the type of the adverse events but not their incidence.…”

Section: Discussionmentioning

confidence: 99%

Early Complications in Endovascular Treatment of Abdominal Aortic Aneurysm

Gabrielli

Baudo

Molinari

et al. 2004

Acta Chirurgica Belgica

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Abstract.Objective : The incidence of perioperative complications during endovascular repair of abdominal aortic aneurysm (EVAR) is reported in limited series. The aim of this study is to evaluate a multi-center survey of unexpected intraprocedural critical events of EVAR. Methods : A questionnaire relative to intraprocedural complications during EVAR was sent to major vascular surgery divisions in Italy. Eleven answered to the survey. The data obtained are relative to 1696 procedures. Results : A wide range of incidence of critical events was observed, from a lower value of 2.7% to a higher value of 68.8% (mean 21.16%). The problems relative to the insertion phase of the delivery system were 7.7%. Endoleaks were reported in 5.5% of cases. Stent graft release was problematic in 0.4% of cases and in another 0.4% there was a problem in shaft retrieval. Unintentional coverage of renal or polar arteries occurred in 0.8% of the procedures ; hypogastric arteries were unwillingly excluded in 2.7% of cases. Aortic or iliac artery rupture had an incidence of 0.7% ; arterial dissection occurred in 0.9%, atheroembolism in 0.5%, lower limb ischemia due to graft limb kinks in 0.7% and to occlusion in 0.9%. Conclusions : Perioperative critical events represent a serious problem only in few cases of EVAR ; they are common but in many cases not predictable ; in most circumstances they can be easily corrected with adjunctive manoeuvres during the same procedure. There is a highly significant correlation between the total workload and the incidence of critical events ; these do not appear to be related to the learning curve.

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“…Although attempts have been made to understand the learning curves associated with various procedures, the neurosurgical and spine literature is lacking any such studies compared with what is found in other surgical fields. 1,2,5,6,8 There are certainly many variables associated with how an individual learns. In an attempt to understand this process we evaluated a single resident/attending team as the resident learned how to perform a minimal-access TLIF.…”

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confidence: 99%

Resident learning curve for minimal-access transforaminal lumbar interbody fusion in a military training program

Neal

Rosner

2010

FOC

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Object Minimal-access transforaminal lumbar interbody fusion (TLIF) has gained popularity as a method of achieving interbody fusion via a posterior-only approach with the aim of minimizing injury to adjacent tissue. While many studies have reported successful outcomes, questions remain regarding the potential learning curve for successfully completing this procedure. The goal of this study, based on a single resident's experience at the only Accreditation Council for Graduate Medical Education–approved neurosurgical training center in the US military, was to determine if there is in fact a significant learning curve in performing a minimal-access TLIF. Methods The authors retrospectively reviewed all minimal-access TLIFs performed by a single neurosurgical resident between July 2006 and January 2008. Minimal-access TLIFs were performed using a tubular retractor inserted via a muscle-dilating exposure to limit approach-related morbidity. The accuracy of screw placement and operative times were assessed. Results A single resident/attending team performed 28 minimal-access TLIF procedures. In total, 65 screws were placed at L-2 (1 screw), L-3 (2 screws), L-4 (18 screws), L-5 (27 screws), and S-1 (17 screws) from the resident's perspective. Postoperative CTs were reviewed to determine the accuracy of screw placement. An accuracy of 95.4% (62 of 65) properly placed screws was noted on postoperative imaging. Two screws (at L-5 in the patient in Case 17 and at S-1 in the patient in Case 9) were lateral, and no revision was needed. One screw (at L-4 in Case 24) was 1 mm medial without symptoms or the need for revision. In evaluating the operative times, 2 deformity cases (Grade III spondylolisthesis) were excluded. The average operating time per level in the remaining 26 cases was 113.25 minutes. The average time per level for the first 13 cases was 121.2 minutes; the amount of time decreased to 105.3 minutes for the second group of 13 cases (p = 0.25). Conclusions In summary, minimal-access TLIF can be safely performed in a training environment without a significant complication rate due to the expected learning curve.

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Cumulative sum failure analysis of the learning curve with endovascular abdominal aortic aneurysm repair

Cited by 82 publications

References 49 publications

Early Experience of Thoracic and Abdominal Endovascular Aortic Repair: a Tertiary Single Centre

Early Experience of Thoracic and Abdominal Endovascular Aortic Repair: a Tertiary Single Centre

Early Complications in Endovascular Treatment of Abdominal Aortic Aneurysm

Resident learning curve for minimal-access transforaminal lumbar interbody fusion in a military training program

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