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. 2023 Mar;37(3):2085-2094.
doi: 10.1007/s00464-022-09726-5. Epub 2022 Oct 27.

Inguinal hernia surgery learning curves by associate clinicians

Jurre van Kesteren  1   2 , Pauline J Meylahn-Jansen  3   4 , Amara Conteh  5 , Birgit I Lissenberg-Witte  6 , Alex J van Duinen  7   8   9 , Thomas Ashley  9   10   11 , H Jaap Bonjer  12   3 , Håkon A Bolkan  7   8   9
Affiliations

Inguinal hernia surgery learning curves by associate clinicians

Jurre van Kesteren et al. Surg Endosc. 2023 Mar.

Abstract

Background: Open inguinal hernia repair is the most commonly performed procedure in general surgery in sub-Saharan Africa, but data on its learning curve are lacking. This study evaluated the learning curve characteristics to improve surgical training and enable scaling up hernia surgery in low- and middle-income countries.

Methods: Logbook data of associate clinicians enrolled in a surgical training program in Sierra Leone were collected and their first 55 hernia surgeries following the Bassini technique (herniorrhaphies) were analyzed in cohorts of five cases. Studied variables were gradient of decline of operating time, variation in operating time, and length of stay (LOS). Eleven subsequent cohorts of each five herniorrhaphies were investigated.

Results: Seventy-five trainees enrolled in the training program between 2011 and 2020 were eligible for inclusion. Thirty-one (41.3%) performed the minimum of 55 herniorrhaphies, and had also complete personal logbook data. Mean operating times dropped from 79.6 (95% CI 75.3-84.0) to 48.6 (95% CI 44.3-52.9) minutes between the first and last cohort, while standard deviation in operating time nearly halved to 15.4 (95% CI 11.7-20.0) minutes, and LOS was shortened by 3 days (8.5 days, 95%CI 6.1-10.8 vs. 5.4 days, 95% 3.1-7.6). Operating times flattened after 31-35 cases which corresponded with 1.5 years of training.

Conclusions: The learning curve of inguinal hernia surgery for associate clinicians flattens after 31-35 procedures. Training programs can be tailored based on this finding. The recorded learning curve may serve as a baseline for future training techniques.

Keywords: Associate clinicians; Hernia surgery; Learning curves; Surgical training; Task sharing.

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Conflict of interest statement

Jurre van Kesteren and Alex J. van Duinen reported having worked in Masanga Hospital Sierra Leone. This is the starting hospital for the associate clinicians enrolled in the Surgical Training Program (STP) organized by CapaCare in collaboration with the Sierra Leone Ministry of Health and Sanitation. Amara Conteh and Thomas Ashley reported having completed the STP. Thomas Ashley, Alex J. van Duinen and Håkon A. Bolkan reported serving as unpaid board member of CapaCare, the nongovernmental organization responsible for organizing the STP. Authors Pauline Jansen, Birgit I. Lissenberg-Witte, and H. Jaap Bonjer have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Inclusion of surgical trainees. None of the trainees enrolled after April 2018 was included, as none had performed the required minimum of 55 herniorrhaphies by the 31st of December 2019. Incomplete logbook data were defined as 3 or more missing operating times
Fig. 2
Fig. 2
Decline of mean operating times for two groups of trainees. The thick black line visualizes the gradient of decline of the mean operating time for the included (n = 31) surgical trainees. The grey area around the black line represents the 95% confidence interval of the operating time in each cohort. The dotted red line visualizes the sub-analysis of 32 surgical trainees that performed fewer than 55 herniorrhaphies. In this graph, the 95% confidence interval is not displayed for this subset of trainees
See this image and copyright information in PMC

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