Objectives: Concept of “learning curve” is well known. But currently, suboptimal results due to learning curve are less tolerated by professional and public, especially in pediatric cardiac surgery. Furthermore, relationship between patient volume and results are matter of concern.
The aim of this study is the assessment of outcomes after arterial switch operation (ASO) in a mid-size center over time, then outcomes for each surgeon, to analyze relationship between institutional and individual surgical learning curves, and its consequences on patient safety.
Methods: We took ASO for transposition of great arteries (TGA) as a model of complex procedure requiring experience. We analyzed and compared mortality and morbidity rates at the institutional level and for each surgeon over time.
Results: From January 1985 to December 2008, 319 ASO were performed in our institution. Institutional mortality rate decreased from 27,7% to 3% (p<0,05) over these 23 years, with a rapid decrease in the 5 first years, time of “learning curve” of surgery and post-operative care. The same evolution was found for the first surgeon, whom performed ASO since 1985. On the other hand, a second surgeon, with the mentorship of the first, and subsequently a third surgeon, experienced a low rate of mortality since their beginnings, in 1990 and 2003 respectively, and institutional mortality rate continued to decrease.
Conclusions: Mentorship, even in a mid-size institution, can offset the lack of experience of young surgeons, allowing them to perform their learning curve without adverse effects on patient safety.