title: Surgical complications in kidney transplantation: no evidence for a learning curve.
abstract: OBJECTIVE
  To evaluate whether surgical complications after kidney transplantation correlate with surgeon's experience and whether individual surgeons' complication rates improve during their learning process.
  
  
  METHODS
  Retrospective analysis: A generalized linear mixed-effects model was used to identify risk factors for surgical complications. Plots of cumulative sums of complications were used to evaluate the individual surgeons' performance.
  
  
  METHODS
  Single-center experience of a teaching hospital in Switzerland.
  
  
  METHODS
  Consecutive kidney transplant recipients operated from 1962 until 2003.
  
  
  RESULTS
  A total of 1496 kidney transplants were analyzed; 73% were from deceased donors and 27% from living donors. At least 1 surgical complication occurred in 352 patients (24%). Male gender (odds ratio [OR] = 1.35, 95% CI: 1.04-1.74), donor's age (OR = 1.14, 95% CI: 1.06-1.24 per decade increment), and third or fourth vs. first or second transplant in a recipient (OR = 2.90, 95% CI: 1.02-8.24) were significantly associated with surgical complications. The surgeon's transplant experience was not found to be associated with surgical complications. Even surgeons with an experience of less than 10 kidney transplants did not have higher complication rates, 30-day mortality, or 1-year graft survival. Individual surgeons' complication rates analyzed by cumulative sum plots did not improve with increasing experience.
  
  
  CONCLUSIONS
  We present the largest single-center study on surgical complications after kidney transplantation, with unique data on the surgeon's experience for every single procedure. We found no evidence for a learning curve during training for kidney transplantation. We conclude that carefully selected experienced general and vascular surgeons can achieve good results in kidney transplantation after a relatively short training period.
authors.affiliation: Department of Vascular and Transplant Surgery, Basel University Hospital, Basel, Switzerland. Electronic address: thomas.wolff@usb.ch.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wolff
authors.affiliation: Department of Vascular and Transplant Surgery, Basel University Hospital, Basel, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Schumacher
authors.affiliation: Department of Vascular and Transplant Surgery, Basel University Hospital, Basel, Switzerland; Basel Institute for Clinical Epidemiology and Biostatistics, Basel, Switzerland.
authors.forename: Salome
authors.initials: S
authors.lastname: Dell-Kuster
authors.affiliation: Department of Vascular and Transplant Surgery, Basel University Hospital, Basel, Switzerland.
authors.forename: Rachel
authors.initials: R
authors.lastname: Rosenthal
authors.affiliation: Division of Transplantation Immunology and Nephrology, Basel University Hospital, Basel, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Dickenmann
authors.affiliation: Division of Transplantation Immunology and Nephrology, Basel University Hospital, Basel, Switzerland.
authors.forename: Jürg
authors.initials: J
authors.lastname: Steiger
authors.affiliation: Department of Urology, Basel University Hospital, Basel, Switzerland.
authors.forename: Alexander
authors.initials: A
authors.lastname: Bachmann
authors.affiliation: Department of Vascular and Transplant Surgery, Basel University Hospital, Basel, Switzerland.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Gürke
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000193:education*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Medical Knowledge; Practice-Based Learning and Improvement; Professionalism; kidney transplantation; learning curve; surgical complications; surgical training