Skill Acquisition

Several studies have shown that procedural outcomes are better at high-volume institutions, because of either greater physician experience or methods of practice. Hospitals with low volumes of aSAH cases were found to have 40% greater odds of patient death in-hospital, compared to hospitals with high case volumes (20). Evidence suggests that the perfecting of endovascular procedures involves a learning curve. In a study that showed that the risk of complications with coil embolization of unruptured aneurysms decreased dramatically with physician experience (21), complications occurred in 53% of the first 5 cases that each of 3 physicians treated, and in only 10% of later cases. Similarly, a second study concluded that 90% of complications occurred in the first half of procedures involving an endoluminal graft, demonstrating a clear learning and development curve (22). Yet another study reported a steep learning curve associated with GDC use in treating aneurysms, finding operator experience critical in achieving optimal therapeutic results (23).

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