Impact of a learning curve model in kidney transplantation on functional outcome and surgical complications in a small volume centre: does size really matter?

被引:12
作者
Fechner, Guido [1 ]
Seifert, Ilja [1 ]
Hauser, Stefan [1 ]
Mueller, Stefan C. [1 ]
机构
[1] Univ Bonn, Dept Urol, D-53105 Bonn, Germany
关键词
Kidney transplantation; Complications; Learning curve; Outcome;
D O I
10.1007/s11255-012-0254-5
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
To evaluate surgical complications and functional results of deceased-donor renal transplantations (DDRT) in a small centre dependent on the surgeons level of experience and to derive a leaning-curve model for DDRT. Three hundred and ninety-two recipients underwent DDRT at the Department of Urology, Bonn University. Operative procedures were performed by 18 various urological surgeons grouped in 5 levels of experience (LOE). Perioperative data, complications and graft survival after 12 months were recorded depending on LOEs. Operative time and warm ischaemia time significantly decreased after an experience of 40 DDRT. Complication rates and graft function after 12 months did not differ between all LOEs. Kidney transplantation in a small centre is a safe and effective procedure even if performed by surgeons under education. As a crucial finding, a surgeon climbing his learning curve becomes faster but not necessarily better.
引用
收藏
页码:1411 / 1415
页数:5
相关论文
共 14 条
[1]   Overconfidence as a cause of diagnostic error in medicine [J].
Berner, Eta S. ;
Graber, Mark L. .
AMERICAN JOURNAL OF MEDICINE, 2008, 121 (05) :2-23
[2]  
Cash H, 2012, BJU INT, P1464
[3]  
Kravetz AJ, 2009, JSLS-J SOC LAPAROEND, V13, P332
[4]   Center-specific graft and patient survival rates - 1997 United Network for Organ Sharing (UNOS) Report [J].
Lin, HM ;
Kauffman, HM ;
McBride, MA ;
Davies, DB ;
Rosendale, JD ;
Smith, CM ;
Edwards, EB ;
Daily, OP ;
Kirklin, J ;
Shield, CF ;
Hunsicker, LG .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1998, 280 (13) :1153-1160
[5]   Does Initial Learning Curve Compromise Outcomes for Robot-Assisted Radical Cystectomy? A Critical Evaluation of the First 60 Cases While Establishing a Robotics Program [J].
Richards, Kyle A. ;
Kader, Karim ;
Pettus, Joseph A. ;
Smith, John J., III ;
Hemal, Ashok K. .
JOURNAL OF ENDOUROLOGY, 2011, 25 (09) :1553-1558
[6]   Volume outcome relationship. Consequences of reallocation of minimum volume based on current German surgical regulations [J].
Roeder, N. ;
Wenke, A. ;
Heumann, M. ;
Franz, D. .
CHIRURG, 2007, 78 (11) :1018-+
[7]   Low Annual Caseloads of United States Surgeons Conducting Radical Prostatectomy [J].
Savage, Caroline J. ;
Vickers, Andrew J. .
JOURNAL OF UROLOGY, 2009, 182 (06) :2677-2679
[8]   Impact of Recipient and Donor Nonimmunologic Factors on the Outcome of Deceased Donor Kidney Transplantation [J].
Shaheen, M. F. ;
Shaheen, F. A. M. ;
Attar, B. ;
Elamin, K. ;
Al Hayyan, H. ;
Al Sayyari, A. .
TRANSPLANTATION PROCEEDINGS, 2010, 42 (01) :273-276
[9]   Surgery-related risk factors [J].
Studer, Peter ;
Inderbitzin, Daniel .
CURRENT OPINION IN CRITICAL CARE, 2009, 15 (04) :328-332
[10]   Hospital Volume is a Determinant of Postoperative Complications, Blood Transfusion and Length of Stay After Radical or Partial Nephrectomy [J].
Sun, Maxine ;
Bianchi, Marco ;
Trinh, Quoc-Dien ;
Abdollah, Firas ;
Schmitges, Jan ;
Jeldres, Claudio ;
Shariat, Shahrokh F. ;
Graefen, Markus ;
Montorsi, Francesco ;
Perrotte, Paul ;
Karakiewicz, Pierre I. .
JOURNAL OF UROLOGY, 2012, 187 (02) :405-410