Laparoscopic colorectal surgery outcomes improved after national training program (LAPCO) for specialists in England
Authors
Hanna, G. B.Mackenzie, H.
Miskovic, D.
Ni, M.
Wyles, S.
Aylin, P.
Parvaiz, A.
Cecil, T.
Gudgeon, A.
Griffith, J.
Robinson, J. M.
Selvasekar, Chelliah
Rockall, T.
Acheson, A.
Maxwell-Armstrong, C.
Jenkins, J. T.
Horgan, A.
Cunningham, C.
Lindsay, I.
Arulampalam, T.
Motson, R. W.
Francis, N. K.
Kennedy, R. H.
Coleman, M. G.
Affiliation
Department of Surgery and Cancer, Imperial College London.Issue Date
2020
Metadata
Show full item recordAbstract
Objective: To examine the impact of The National Training Programme for Laparoscopic Colorectal Surgery (Lapco) on the rate of laparoscopic surgery and clinical outcomes of cases performed by Lapco surgeons after completion of training. Summery 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: 108 Lapco delegates performed 4586 elective colorectal resections pre-Lapco and 5115 post-Lapco while non-Lapco surgeons performed 72930 matched cases. Lapco delegates had a 37.8% increase in laparoscopic surgery which was greater than non-Lapco surgeons by 20.9% (95% CI, 18.5 to 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.Citation
Hanna GB, Mackenzie H, Miskovic D, Ni M, Wyles S, Aylin P, et al. Laparoscopic Colorectal Surgery Outcomes Improved After National Training Program (LAPCO) for Specialists in England. Ann Surg. 2020.Journal
Annals of SurgeryDOI
10.1097/sla.0000000000004584PubMed ID
33086313Additional Links
https://dx.doi.org/10.1097/sla.0000000000004584Type
ArticleLanguage
enae974a485f413a2113503eed53cd6c53
10.1097/sla.0000000000004584
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