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Article |

The Learning Curve for Laparoscopic Colorectal Surgery

Samuel R. G. Finlayson, MD, MPH; John D. Birkmeyer, MD
Arch Surg. 1997;132(8):931. doi:10.1001/archsurg.1997.01430320133025.
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In the January issue of the Archives, Bennett et al1 described a prospective analysis of 1194 patients undergoing laparoscopic-assisted colorectal surgery.1 The rate of postoperative complications with operations performed by high-volume (>40 procedures) surgeons was significantly lower than with operations performed by low-volume (<40 procedures) surgeons (9.9% vs 18.6%, P<.001). The authors assert that these findings support the presence of a "learning curve" for laparoscopic-assisted colectomy.

However, a close examination of the data suggests otherwise. The authors used volume as a dichotomous variable (high vs low), and their cutoff point (40 procedures) was defined retrospectively. Had the authors selected a different volume threshold, their conclusions would have been different. Furthermore, if the analysis were performed using volume as a continuous variable, a learning curve would not have been discernible at all. In fact, if the numbers reported in the article's Table are used to plot volume vs


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