AI Article Synopsis
- This study tracks the learning curve of complex endovascular aortic repair (EVAR) over time in a non-high-volume academic center, analyzing both quantitative outcomes like operating time and hospital stay, and qualitative factors impacting the learning process.
- Results showed significant reductions in hospital stays and operating times, with fewer cardiac complications noted in the later temporal group, although no significant differences were found in major adverse events or 30-day mortality rates.
- Qualitative insights identified by the treatment team included the importance of communication, trust, shared responsibility, clear structures, and team capabilities as key contributors to effectively implementing new techniques.
Article Abstract
Background: When introducing new techniques, attention must be paid to learning curve. Besides quantitative outcomes, qualitative factors of influence should be taken into consideration. This retrospective cohort study describes the quantitative learning curve of complex endovascular aortic repair (EVAR) in a nonhigh-volume academic center and provides qualitative factors that were perceived as contributors to this learning curve. With these factors, we aim to aid in future implementation of new techniques.
Methods: All patients undergoing complex EVAR in the Leiden University Medical Center (LUMC) between July 2013 and April 2021 were included (n = 90). Quantitative outcomes were as follows: operating time, blood loss, volume of contrast, hospital stay, major adverse events (MAE), 30-day mortality, and complexity. Patients were divided into 3 temporal groups (n = 30) for dichotomous outcomes. Regression plots were used for continuous outcomes. In 2017, the treatment team was interviewed by an external researcher. These interviews were reanalyzed for factors that contributed to successful implementation.
Results: Length of hospital stay (P = 0.008) and operating time (P = 0.010) decreased significantly over time. Fewer cardiac complications occurred in the third group (3: 0% vs. 2: 17% vs. 1: 17%, P = 0.042). There was a trend of increasing complexity (P = 0.076) and number of fenestrations (P = 0.060). No significant changes occurred in MAE and 30-day mortality. Qualitative factors that, according to the interviewees, positively influenced the learning curve were as follows: communication, mutual trust, a shared sense of responsibility and collective goals, clear authoritative structures, mutual learning, and team capabilities.
Conclusions: In addition to factors previously identified in the literature, new learning curve factors were found (mutual learning and shared goals in the operating room (OR)) that should be taken into account when implementing new techniques.
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| http://dx.doi.org/10.1016/j.avsg.2023.01.044 | DOI Listing |
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