Quantitative assessment of the learning curve for cleft lip repair using LC-CUSUM

Segna, E.; Caruhel, Jean-Baptiste; Corre, Pierre; Picard, A.; Biau, David; Khonsari, R.H.

doi:10.1016/j.ijom.2017.10.005

Cited by 7 publications

(4 citation statements)

References 14 publications

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“…After achieving surgical competence, we applied the standard CUSUM to ensure the complication rate did not deviate from optimal performance. A more detailed description of LC-CUSUM and standard CUSUM with regards to the formulation, performance, and limits, is provided elsewhere [15,16,17]. Since the two largest series including over 1000 patients showed transient hypoparathyroidism rates of 48.1% and 39.1%, the unacceptable failure rate was set as 0.5 (transient hypoparathyroidism occurring in 50% of patients) during the learning curve period in the present study [18,19].…”

Section: Methodsmentioning

confidence: 99%

Quantitative Assessment of the Learning Curve for Robotic Thyroid Surgery

Kim

Kwon

Lim

et al. 2019

JCM

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With the increased utilization of robot thyroidectomy in recent years, surgical proficiency is the paramount consideration. However, there is no single perfect or ideal method for measuring surgical proficiency. In this study, we evaluated the learning curve of robotic thyroidectomy using various parameters. A total of 172 robotic total thyroidectomies were performed by a single surgeon between March 2014 and February 2018. Cumulative summation analysis revealed that it took 50 cases for the surgeon to significantly improve the operation time. Mean operation time was significantly shorter in the group that included the 51st to the 172nd case, than in the group that included only the first 50 cases (132.8 ± 27.7 min vs. 166.9 ± 29.5 min; p < 0.001). On the other hand, the surgeon was competent after the 75th case when postoperative transient hypoparathyroidism was used as the outcome measure. The incidence of hypoparathyroidism gradually decreased from 52.0%, for the first 75 cases, to 40.2% after the 76th case. These results indicated that the criteria used to assess proficiency greatly influenced the interpretation of the learning curve. Incorporation of the operation time, complications, and oncologic outcomes should be considered in learning curve assessment.

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Section: Methodsmentioning

confidence: 99%

Quantitative Assessment of the Learning Curve for Robotic Thyroid Surgery

Kim

Kwon

Lim

et al. 2019

JCM

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“…Even with this training, we acknowledge that the use of endoscopic surgery in this context is new and its adoption should be done judiciously. However, the concept of gradually attaining proficiency is clearly demonstrated throughout the general surgical,24 neurosurgical25 26 and other surgical specialty literatures 27 28. As long as newly trained surgeons have received proper instruction and demonstrated competence in both technique and judgement, it is reasonable for them to proceed in appropriate clinical circumstances when they are comfortable.…”

Section: Discussionmentioning

confidence: 99%

The CURE Protocol: evaluation and external validation of a new public health strategy for treating paediatric hydrocephalus in low-resource settings

et al. 2020

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IntroductionManaging paediatric hydrocephalus with shunt placement is especially risky in resource-limited settings due to risks of infection and delayed life-threatening shunt obstruction. This study evaluated a new evidence-based treatment algorithm to reduce shunt-dependence in this context.MethodsA prospective cohort design was used. The CURE Protocol employs preoperative and intraoperative data to choose between endoscopic treatment and shunt placement. Data were prospectively collected for 730 children in Uganda (managed by local neurosurgeons highly experienced in the protocol) and, for external validation, 96 children in Nigeria (managed by a local neurosurgeon trained in the protocol).ResultsThe age distribution was similar between Uganda and Nigeria, but there were more cases of postinfectious hydrocephalus in Uganda (64.2% vs 26.0%, p<0.001). Initial treatment of hydrocephalus was similar at both centres and included either a shunt at first operation or endoscopic management without a shunt. The Nigerian cohort had a higher failure rate for endoscopic cases (adjusted HR 2.5 (95% CI 1.6 to 4.0), p<0.001), but not for shunt cases (adjusted HR 1.3 (0.5 to 3.0), p=0.6). Despite the difference in endoscopic failure rates, a similar proportion of the entire cohort was successfully treated without need for shunt at 6 months (55.2% in Nigeria vs 53.4% in Uganda, p=0.74).ConclusionUse of the CURE Protocol in two centres with different populations and surgeon experience yielded similar 6-month results, with over half of all children remaining shunt-free. Where feasible, this could represent a better public health strategy in low-resource settings than primary shunt placement.

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“…The maintenance of the performance level afterwards can be monitored using the CUSUM test. These tests have been used in several medical and surgical fields [7][8][9][10][11][12][13], as well as in the field of Obstetrics and Gynecology, for many procedures such as fetoscopic laser surgery [14], ultrasound diagnosis of endometriosis [15,16] and hysteroscopy [17]. In the field of REI, it has been used for embryo transfer and 3dimensional sonographic monitoring during ovarian stimulation, but only once for it has OR [18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Assessment of operator performance during oocyte retrievals: residents’ learning curve and continuous monitoring of senior physicians

et al. 2021

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Background The learning curve cumulative summation test (LC CUSUM test) allows to define an individualized learning curve and determine the moment when clinical proficiency is attained. After acquisition of the skills, the cumulative summation test (CUSUM test) allows to monitor the maintenance of the required level over time. The LC CUSUM test has been frequently used in the field of Obstetrics and Gynecology (Ob/Gyn) for several procedures, but only once for OR. Methods We performed a retrospective study at Angers university hospital between May 2017 and September 2018. Seven Ob/Gyn residents and 5 senior physicians were included, and all OR performed during that time (n = 690) were analyzed. The performance index assessed was the oocyte retrieval rate (ORR), defined as the ratio of oocytes retrieved to follicles aspirated. We used the LC CUSUM test to analyze the learning curves of residents, and the CUSUM test to monitor the performance of senior physicians. An ORR ≥50% in 60% of retrievals was defined as the threshold for clinical proficiency. Results Six hundred seventy-four oocyte retrieval (OR) were included: 315 were performed by residents, 220 by senior physicians, and 139 by both residents and physicians (mixed retrievals). Four residents (57%) reached the threshold after aspirating 82, 67, 53 and 46 ovaries, respectively. The mean number of ovaries aspirated in order to reach clinical proficiency was 62, and the mean number of weeks needed was 21. The duration of the learning period varied between 26 and 80 days. Two senior physicians (40%) remained proficient across the duration of the study, while two physicians (40%) had one statistically “suboptimal” OR, and one physician (20%) had two suboptimal retrievals. Conclusion There is a large variability in the duration of the learning period and the number of procedures needed for a resident to master OR. Senior physicians maintain an adequate performance.

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Quantitative assessment of the learning curve for cleft lip repair using LC-CUSUM

Cited by 7 publications

References 14 publications

Quantitative Assessment of the Learning Curve for Robotic Thyroid Surgery

Quantitative Assessment of the Learning Curve for Robotic Thyroid Surgery

The CURE Protocol: evaluation and external validation of a new public health strategy for treating paediatric hydrocephalus in low-resource settings

Assessment of operator performance during oocyte retrievals: residents’ learning curve and continuous monitoring of senior physicians

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