title: The Preceding Surgeon Factor in Bariatric Surgery: a Positive Influence on the Learning Curve of Subsequent Surgeons.
abstract: BACKGROUND
  The learning curve of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery has been well investigated. The learning curve is defined by complications and/or by duration of surgery (DOS). Previous studies report an inverse relationship between patient outcome and patient volume. In this study, we investigate whether the learning curve of preceding bariatric surgeons is of additional influence for surgeons who start to perform LRYGB in the same centre.
  
  
  METHODS
  We retrospectively analysed the records of all 713 consecutive primary LRYGB patients operated in our centre from December 2007 until July 2012. Surgeon 1 and 3 had previous laparoscopic bariatric experience whilst Surgeon 2 and 4 had not. We stratified the data between the four surgeons with different levels of experience and in a chronology of 50 cases.
  
  
  RESULTS
  Sixty-seven (9.4 %) complications occurred in the study period. Surgeon 1 had more complications occurring within the first 50 cases than Surgeon 4 (10 versus 1, p < 0.05). There was no difference in complication rate between groups of 50 consecutive cases. None of the patients died. DOS decreased for every consecutive surgeon, irrespective of their experience. The learning curve defined by DOS was steepest for Surgeon 1, followed by Surgeon 2, 3 and 4.
  
  
  CONCLUSIONS
  In this study, we show that the learning curve of the preceding surgeon positively influences the learning curve of latter surgeons, irrespective of their experience. Therefore, the 'preceding surgeon factor' should be taken in account in addition to volume requirements when starting new bariatric facilities.
authors.affiliation: Department of Metabolic and Bariatric Surgery, Slotervaart Hospital, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands, ngeubbels@gmail.com.
authors.forename: Noëlle
authors.initials: N
authors.lastname: Geubbels
authors.forename: L Maurits
authors.initials: LM
authors.lastname: de Brauw
authors.forename: Yair I Z
authors.initials: YI
authors.lastname: Acherman
authors.forename: Arnold W J M
authors.initials: AW
authors.lastname: van de Laar
authors.forename: Michel W J M
authors.initials: MW
authors.lastname: Wouters
authors.forename: Sjoerd C
authors.initials: SC
authors.lastname: Bruin
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000193:education* / Q000706:statistics & numerical data; D002983:Clinical Competence; D005260:Female; D015390:Gastric Bypass / Q000193:education / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000193:education / Q000706:statistics & numerical data; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D066231:Surgeons / Q000193:education / Q000523:psychology