title: Surgical learning curves and operative efficiency: a cross-specialty observational study.
abstract: OBJECTIVE
  To evaluate the learning curves of three high-volume procedures, from distinct surgical specialties.
  
  
  METHODS
  Tertiary care academic hospital.
  
  
  METHODS
  A prospectively collected database comprising all medical records of patients undergoing isolated coronary artery bypass grafting (CABG), total knee replacement (TKR) and bilateral reduction mammoplasty (BRM) at the Brigham and Women's Hospital, USA, 1996-2010. Multivariate generalised estimating equation (GEE) regression models were used to adjust for patient risk and clustering of procedures by surgeon.
  
  
  METHODS
  Operative efficiency.
  
  
  RESULTS
  A total of 1052 BRMs, 3254 CABGs and 3325 TKRs performed by 30 surgeons were analysed. Median number of procedures per surgeon was 61 (range 11-502), 290 (52-973) and 99 (10-1871) for BRM, CABG and TKR, respectively. Mean operative times were 134.4 (SD 34.5), 180.9 (62.3) and 101.9 (30.3) minutes, respectively. For each procedure, attending surgeon experience was associated with significant reductions in operative time (p<0.05). After 15 years of experience, BRM operative time decreased by 69.8 min (38.3%), CABG operative time decreased by 17.5 min (7.8%) and TKR operative time decreased by 94.4 min (48.4%).
  
  
  CONCLUSIONS
  Common trends in surgical learning exist. Dependent on the procedure, experience can serve as a powerful driver of improvement or have clinically insignificant impacts on operative time.
authors.affiliation: Brigham and Women's Hospital Center for Surgery and Public Health, Boston, Massachusetts, USA.
authors.forename: Mahiben
authors.initials: M
authors.lastname: Maruthappu
authors.affiliation: Brigham and Women's Hospital Center for Surgery and Public Health, Boston, Massachusetts, USA Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche-Université de Lyon, Lyon, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Duclos
authors.affiliation: Brigham and Women's Hospital Center for Surgery and Public Health, Boston, Massachusetts, USA.
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.affiliation: Brigham and Women's Hospital Center for Surgery and Public Health, Boston, Massachusetts, USA Division of Plastic Surgery, Brigham and Women's Hospital/Faulkner Hospital, Jamaica Plain, Massachusetts, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Orgill
authors.affiliation: Brigham and Women's Hospital Center for Surgery and Public Health, Boston, Massachusetts, USA Division of Plastic Surgery, Brigham and Women's Hospital/Faulkner Hospital, Jamaica Plain, Massachusetts, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Carty
mesh_terms: D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D002983:Clinical Competence; D001026:Coronary Artery Bypass; D004526:Efficiency; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D016462:Mammaplasty; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D013043:Specialties, Surgical; D013997:Time Factors; D055815:Young Adult
keywords: MEDICAL EDUCATION & TRAINING; PUBLIC HEALTH; SURGERY