BACKGROUND: Minimal access surgery for @entity1820 has short-term benefits but is associated with a proficiency-gain curve. The aim of this study was to define national proficiency-gain curves for minimal access colorectal and oesophagogastric surgery, and to determine the impact on clinical outcomes. METHODS: All adult @entity1 undergoing minimal access oesophageal, colonic and rectal surgery between 2002 and 2012 were identified from the Hospital Episode Statistics database. Proficiency-gain curves were created using risk-adjusted cumulative sum analysis. Change points were identified, and bootstrapping was performed with 1000 iterations to identify a confidence level. The primary outcome was 30-day mortality; secondary outcomes were 90-day mortality, reintervention, conversion and length of hospital stay. RESULTS: Some 1696, 15   008 and 16   701 minimal access oesophageal, rectal and @entity694 resections were performed during the study period. The change point in the proficiency-gain curve for 30-day mortality for oesophageal, rectal and colonic surgery was 19 (confidence level 98  4 per cent), 20 (99  2 per cent) and three (99  5 per cent) procedures; the mortality rate fell from 4  0 to 2  0 per cent (relative risk reduction (RRR) 0  50, P   =   0  033), from 2  1 to 1  2 per cent (RRR 0  43, P   <   0  001) and from 2  4 to 1  8 per cent (RRR 0  25, P   =   0  058) respectively. The change point in the proficiency-gain curve for reintervention in oesophageal, rectal and colonic resection was 19 (98  1 per cent), 32 (99  5 per cent) and 26 (99  2 per cent) procedures respectively. There were also significant proficiency-gain curves for 90-day mortality, conversion and length of stay. CONCLUSION: The introduction of minimal access @entity1820 surgery has been associated with a proficiency-gain curve for mortality and major morbidity at a national level. Unnecessary @entity1 harm should be avoided by appropriate training and monitoring of new surgical techniques.

National proficiency-gain curves for minimally invasive XXXX surgery.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity694 :: ('MESH:D003110', 'Disease') :: ['colonic cancer'] @entity1820 :: ('MESH:D005770', 'Disease') :: ['gastrointestinal cancer']
@entity1820 :: (MESH:D005770,Disease) :: ['gastrointestinal cancer']
