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After adjusting for patient characteristics and clustering, we found a significant association between operative time and attending surgeon experience entered both as a linear (p Cyclopamine chemical structure data and techniques, our study permits identification of important commonalities and differentiations, yielding several important findings. First, KU 60019 in contrast to the notion that efficiency is optimised within a fairly narrow temporal window following the start of clinical practice, our data suggest that operative learning curves, for some procedures, exhibit ongoing improvement in efficiency over the course of a surgeon's career, with time courses much longer than previously anticipated. This emphasises the necessity to draw equitable comparisons between surgeons at similar stages of the learning curve,11 12 and supports proposals for continual monitoring, training and behavioural interventions aiming to accelerate operative maturation.13 Second, our results demonstrate the different learning curve dynamics that exist between procedures. BRM is typified by an initial phase of variability, followed by a period of rapid improvement, followed by a relative plateau phase. TKR and CABG, on the other hand, PIK-3 demonstrate a more linear improvement over time. Such findings suggest that certain procedures may demonstrate characteristic learning curves, with some achieving maturation more rapidly than others. The factors contributing to these characteristics should be the subject of further investigation. Third, the magnitude of improvements in efficiency over time varies from procedure to procedure. In some cases, efficiency is markedly augmented with increasing surgeon experience (BRM and TKR); in others, however, the improvement is substantially more marginal, and possibly clinically insignificant (CABG;