title: Credentialing for laparoscopic bowel operation: there is no substitute for knowing the outcomes.
abstract: BACKGROUND
  Case volume and training have been considered as reasonable surrogates for competency that can be used as a basis to grant privileges for performing laparoscopic operations. To determine the validity of this practice, we assessed the relationship of surgical volume and training to provider-related complications after laparoscopic bowel resection.
  
  
  METHODS
  All patients undergoing open or laparoscopic resection at a university hospital from July 2003 to June 2006 were entered into a prospectively maintained database. Complications were recorded by a specially trained nurse practitioner and adjudicated monthly by a team of gastrointestinal surgeons. Surgeon case volume, training, and operative indication were assessed for their ability to predict technical complications after laparoscopic resection using a logistic regression model.
  
  
  RESULTS
  Six hundred twenty-four bowel resections were performed during the study period, of which 112 were performed laparoscopically. Of the four study surgeons, the percentage of laparoscopic versus open cases ranged from 8% to 56%. Individual surgeon complication rates varied from 9% to 47%. Surgical volume and training had no notable relationship to incidence of complications (19% high volume/fellowship training versus 10% low volume/no fellowship, p = 0.25). An inflammatory indication was a strong predictor of technical complications on univariate (p = 0.02) and multivariate (p = 0.01) analysis.
  
  
  CONCLUSIONS
  Surgeon case volume and training had no relationship to the complication rate after laparoscopic bowel operation. Case selection is a critical confounding variable because surgeons vary so greatly in their indications for using laparoscopic technique. Although documentation of training is appropriately considered in granting privileges, actually tracking outcomes is likely the only reliable way to assess competency.
authors: Department of Surgery, University of Vermont College of Medicine, Fletcher Allen Health Care, Burlington, VT 05401, USA. neil.hyman@vtmednet.org
authors: Neil
authors: N
authors: Hyman
authors: Edward
authors: E
authors: Borrazzo
authors: Gino
authors: G
authors: Trevisani
authors: Turner
authors: T
authors: Osler
authors: Steven
authors: S
authors: Shackford
mesh_terms: D002983:Clinical Competence; D003406:Credentialing; D006801:Humans; D007422:Intestines / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D016896:Treatment Outcome