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@article{Hanna:2022:10.1097/SLA.0000000000004584,
author = {Hanna, GB and Mackenzie, H and Miskovic, D and Ni, M and Wyles, S and Aylin, P and Parvaiz, A and Cecil, T and Gudgeon, A and Griffith, J and Robinson, JM and Selvasekar, C and Rockall, T and Acheson, A and Maxwell-Armstrong, C and Jenkins, JT and Horgan, A and Cunningham, C and Lindsay, I and Arulampalam, T and Motson, RW and Francis, NK and Kennedy, RH and Coleman, MG and Lapco, program},
doi = {10.1097/SLA.0000000000004584},
journal = {Annals of Surgery},
pages = {1149--1155},
title = {Laparoscopic colorectal surgery outcomes improved after national training program (LAPCO) for specialists in England},
url = {http://dx.doi.org/10.1097/SLA.0000000000004584},
volume = {275},
year = {2022}
}

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TY  - JOUR
AB  - 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.
AU  - Hanna,GB
AU  - Mackenzie,H
AU  - Miskovic,D
AU  - Ni,M
AU  - Wyles,S
AU  - Aylin,P
AU  - Parvaiz,A
AU  - Cecil,T
AU  - Gudgeon,A
AU  - Griffith,J
AU  - Robinson,JM
AU  - Selvasekar,C
AU  - Rockall,T
AU  - Acheson,A
AU  - Maxwell-Armstrong,C
AU  - Jenkins,JT
AU  - Horgan,A
AU  - Cunningham,C
AU  - Lindsay,I
AU  - Arulampalam,T
AU  - Motson,RW
AU  - Francis,NK
AU  - Kennedy,RH
AU  - Coleman,MG
AU  - Lapco,program
DO  - 10.1097/SLA.0000000000004584
EP  - 1155
PY  - 2022///
SN  - 0003-4932
SP  - 1149
TI  - Laparoscopic colorectal surgery outcomes improved after national training program (LAPCO) for specialists in England
T2  - Annals of Surgery
UR  - http://dx.doi.org/10.1097/SLA.0000000000004584
UR  - https://www.ncbi.nlm.nih.gov/pubmed/33086313
UR  - https://journals.lww.com/annalsofsurgery/Abstract/9000/Laparoscopic_Colorectal_Surgery_Outcomes_Improved.94080.aspx
UR  - http://hdl.handle.net/10044/1/84223
VL  - 275
ER  -

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