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Operator Learning Curve for Prostatic Artery Embolization and Its Impact on Outcomes in 296 Patients.

Taylor Powell¹, Saumik Rahman¹, Lawrence Staib¹

¹Yale University School of Medicine, New Haven, CT, USA.

Cardiovascular and Interventional Radiology

|December 1, 2022

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Technical efficiency in prostatic artery embolization (PAE) stabilizes around 73-78 procedures. New operators can safely perform PAE effectively from the start, with consistent clinical outcomes and low adverse events regardless of experience.

Area of Science:

Interventional Radiology
Vascular Medicine
Urology

Background:

Benign prostatic hyperplasia (BPH) significantly impacts quality of life.
Prostatic artery embolization (PAE) is an established treatment for BPH.
Understanding the learning curve for PAE is crucial for safe and effective implementation.

Purpose of the Study:

To determine the learning curve inflection points for prostatic artery embolization (PAE).
To assess the impact of operator experience on technical efficiency during PAE.
To evaluate the relationship between PAE experience and clinical outcomes and adverse events.

Main Methods:

A cohort of 296 patients undergoing PAE by an inexperienced interventional radiologist was analyzed.
Procedure time, fluoroscopy time, and contrast volume were tracked against sequential procedure number.

Keywords:

Benign prostatic hyperplasia Gross hematuria Learning curve Lower urinary tract symptoms Prostatic artery embolization Urinary retention

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Segmented linear regression identified learning curve inflection points; regression analysis assessed impacts on outcomes and adverse events.

Main Results:

Technical efficiency, measured by procedure time and fluoroscopy time, improved significantly, with inflection points around 73-78 procedures.
Contrast volume also showed experience-dependent improvement, though not statistically significant at the inflection point.
Clinical outcomes (symptom scores, quality of life, post-void residual) and adverse event rates were substantial and did not vary with operator experience.

Conclusions:

Operator technical efficiency in PAE plateaus after approximately 73-78 procedures.
PAE can be performed safely and effectively by operators without prior specific experience from the outset.
Clinical benefits and safety profile of PAE are consistent, irrespective of the operator's experience level.