Impact of Fellowship-trained Laparoscopic Surgeons On Rates

Garth H Ballantyne, MD MBA, Eric A Sommer, MD, Heidi Elliott, MD. Lawrence & Memorial Hospital

INTRODUCTION: Many of the early pioneers of Laparoscopic General Surgery practiced in Community Hospitals. Although Evidence-Based Medicine demands the use of minimally invasive techniques, penetration of laparoscopic approaches to General Surgery procedures has remained poor at many community hospitals. Recently, two Fellowship-Trained Advanced Laparoscopic Surgeons and one senior Advanced Laparoscopic Surgeon joined the Medical Staff of a community hospital in South-Eastern Connecticut. The number of General Surgeons at this hospital had declined from 12 to three at the time of the arrival of the three Advanced Laparoscopic Surgeons in 2010.How did the arrival of these Advanced Laparoscopic Surgeons impact practice patterns at this hospital in the use of minimally invasive techniques?

AIM: The aim of this study is to illustrate the impact of Fellowship-Trained Advanced Laparoscopic Surgeons on the rates of Open and Laparoscopic General Surgery Procedures in a Community Hospital.

METHODS: Corrected case logs for General Surgery Procedures at Lawrence & Memorial Hospital were obtained from the Operating Room Scheduling System for the years 1998 through September, 2011. Rates of Open and Laparoscopic Operations are expressed as percentage. Statistical comparisons of groups were accomplished using ANOVA (Data Analysis Package, Excel 2007, Microsoft).

RESULTS: Surgeons have performed Advanced Laparoscopic Operations at Lawrence & Memorial Hospital since at least 1998 when our data commences. The rate of Open Adult Appendectomies average 30% but dropped to 10% in 2010 and 0% in 1011. Rates of Open Elective Cholecystectomy have remained stable at about 3.5% throughout the 14 years of this study (see figure).

Rates of Open Urgent Cholecystectomies have dropped from an average of 11.6 % to 5.8% since the arrival of the Advanced Laparoscopic Surgeons. Open Adult Inguinal Hernias averaged 75% but dropped to 64% in 2010 and 51% in 2011. Rates of Open Elective Colorectal Operations dropped from 100% in 2003 to 36% in 2010 and 25% in 2011.

Conclusion: General Surgeons in a Community Hospital performed Advanced Laparoscopic Operations throughout the last 14 years. The rates of Open Operations, however, significantly dropped after the addition of Fellowship-Trained Advanced Laparoscopic Surgeons to the hospital’s Medical Staff. Fellowship-Trained Advanced laparoscopic Surgeons speed the adoption of Advanced Laparoscopic Procedures in a Community Hospital.
 

View Poster