PREDICTORS OF LAPAROSCOPIC COMPLICATIONS AFTER FORMAL TRAINING IN LAPAROSCOPIC SURGERY

Objective.-To evaluate the relationship between laparoscopic complicat ion rates and surgeon-dependent variables following a laparoscopic tra ining course. Design.-Participants were surveyed regarding their inter val laparoscopic experience 3 months and 12 months after the course. P articipants.-Course participants/survey respondents represented a cros s section of urologic surgeons in the United States. A total of 181 in dividuals (61% of 297 participants) completed and returned the 3-month questionnaire. A total of 128 surgeons responded to the 12-month ques tionnaire (78.5% of 163 participants). Main Outcome Measure.-Logistic regression analysis tested the relationship between surgeons' complica tion rates and study variables. Results.-At 3 months, surgeons who per formed clinical procedures without additional training were 3.39 times more likely to have at least one complication compared with surgeons who sought additional training (P=.03). At 12 months, surgeons who had attended the training course alone, were in solo practice, or perform ed laparoscopic surgery with a variable assistant were 4.85, 7.74, and 4.80 times more likely, respectively, to have had a complication than their counterparts who attended the course with a partner, were in gr oup practice, or operated with the same assistant (P=.004, P=.0008, an d P=.0015, respectively). At both 3 and 12 months, laparoscopic compli cation rates of individual surgeons demonstrated a significant inverse correlation with the number of laparoscopic procedures performed. Con clusions.-The rate of complications associated with the clinical learn ing curve can be decreased by additional education following an initia l course in laparoscopy. An ongoing clinical association with surgeons performing similar procedures decreases long-term complication rates.