George B Hanna1, Hugh Mackenzie1, Danilo Miskovic1,2, Melody Ni1, Susannah Wyles1, Paul Aylin3, Amjad Parvaiz4, Tom Cecil5, Andrew Gudgeon6, John Griffith7, Jonathan M Robinson7, Chelliah Selvasekar8, Tim Rockall9, Austin Acheson3, Charles Maxwell-Armstrong3, John T Jenkins1,2, Alan Horgan10, Chris Cunningham11, Ian Lindsey11, Tan Arulampalam12, Roger W Motson12, Nader K Francis13, Robin H Kennedy1,2, Mark G Coleman14. 1. Department of Surgery and Cancer, Imperial College London, London, United Kingdom. 2. Department of Colorectal Surgery, St Mark's Hospital, North West London NHS Trust, London, United Kingdom. 3. Department of Gastrointestinal Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom. 4. Department of Surgery, Poole General Hospital, Poole, United Kingdom. 5. Department of Colorectal Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, United Kingdom. 6. Department of Colorectal Surgery, Frimley Park Hospital, Frimley, United Kingdom. 7. Department of Colorectal Surgery, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom. 8. Department of Colorectal Surgery, Christie NHS Foundation Trust, Man chester, United Kingdom. 9. Department of Colorectal Surgery, Royal Surrey County Hospital NHS Trust, Guildford, United Kingdom. 10. Department of Colorectal Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle, United Kingdom. 11. Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom. 12. Department of Colorectal Surgery, Colchester Hospital, East Suffolk and North Essex NHS Foundation Trust, Colchester, United Kingdom. 13. Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, United Kingdom. 14. Department of Colorectal Surgery, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom.
Abstract
OBJECTIVE: To examine the impact of The National Training Program for Lapco on the rate of laparoscopic surgery and clinical outcomes of cases performed by Lapco surgeons after completion of training. SUMMARY OF BACKGROUND DATA: Lapco provided competency-based supervised clinical training for specialist colorectal surgeons in England. METHODS: We compared the rate of laparoscopic surgery, mortality, and morbidity for colorectal cancer resections by Lapco delegates and non-Lapco surgeons in 3-year periods preceding and following Lapco using difference in differences analysis. The changes in the rate of post-Lapco laparoscopic surgery with the Lapco sign-off competency assessment and in-training global assessment scores were examined using risk-adjusted cumulative sum to determine their predictive clinical validity with predefined competent scores of 3 and 5 respectively. RESULTS: One hundred eight Lapco delegates performed 4586 elective colo-rectal resections pre-Lapco and 5115 post-Lapco while non-Lapco surgeons performed 72,930 matched cases. Lapco delegates had a 37.8% increase in laparoscopic surgery which was greater than non-Lapco surgeons by 20.9% [95% confidence interval (CI), 18.5-23.3, P < 0.001) with a relative decrease in 30-day mortality by -1.6% (95% CI, -3.4 to -0.2, P = 0.039) and 90-day mortality by -2.3% (95% CI, -4.3 to -0.4, P = 0.018). The change point of risk-adjusted cumulative sum was 3.12 for competency assessment tool and 4.74 for global assessment score whereas laparoscopic rate increased from 44% to 66% and 40% to 56%, respectively. CONCLUSIONS: Lapco increased the rate of laparoscopic colorectal cancer surgery and reduced mortality and morbidity in England. In-training competency assessment tools predicted clinical performance after training.
OBJECTIVE: To examine the impact of The National Training Program for Lapco on the rate of laparoscopic surgery and clinical outcomes of cases performed by Lapco surgeons after completion of training. SUMMARY OF BACKGROUND DATA: Lapco provided competency-based supervised clinical training for specialist colorectal surgeons in England. METHODS: We compared the rate of laparoscopic surgery, mortality, and morbidity for colorectal cancer resections by Lapco delegates and non-Lapco surgeons in 3-year periods preceding and following Lapco using difference in differences analysis. The changes in the rate of post-Lapco laparoscopic surgery with the Lapco sign-off competency assessment and in-training global assessment scores were examined using risk-adjusted cumulative sum to determine their predictive clinical validity with predefined competent scores of 3 and 5 respectively. RESULTS: One hundred eight Lapco delegates performed 4586 elective colo-rectal resections pre-Lapco and 5115 post-Lapco while non-Lapco surgeons performed 72,930 matched cases. Lapco delegates had a 37.8% increase in laparoscopic surgery which was greater than non-Lapco surgeons by 20.9% [95% confidence interval (CI), 18.5-23.3, P < 0.001) with a relative decrease in 30-day mortality by -1.6% (95% CI, -3.4 to -0.2, P = 0.039) and 90-day mortality by -2.3% (95% CI, -4.3 to -0.4, P = 0.018). The change point of risk-adjusted cumulative sum was 3.12 for competency assessment tool and 4.74 for global assessment score whereas laparoscopic rate increased from 44% to 66% and 40% to 56%, respectively. CONCLUSIONS: Lapco increased the rate of laparoscopic colorectal cancer surgery and reduced mortality and morbidity in England. In-training competency assessment tools predicted clinical performance after training.