The Learning Curve of a Craniofacial Surgeon: A Retrospective Study of 100 Consecutive Cases

Abstract

Mastering the techniques of craniofacial surgery is difficult owing to the small number of cases and the special skills required. To improve the outcomes of craniofacial surgery in Japan, the authors charted the progress of a craniofacial surgeon by reviewing the results for the 100 consecutive craniosynostosis cases, in which the authors performed fronto-orbital advancement (FOA). in this study, all FOA surgeries were performed by the first author beginning in 2012. The number of FOA surgeries previously performed by the surgeon at the time of the current surgery served as an indicator of his level of experience; the cases were grouped in 5 consecutive sets of 20. The preparation time before the operation, the operative time, and the amount of bleeding were retrospectively investigated. The operative and preparation times decreased as the surgeon's experience increased until a plateau was reached after 41 to 60 surgeries. Increases in operative time also corresponded to decreases in the amount of bleeding. Everyone has a learning curve, including surgeons performing craniofacial surgeries. Surgery is not performed by the surgeon alone. Reductions in preparation time, operative time, and the time needed to leave the operation room after the completion of the surgery were attributed to better collaborations with nurses and anesthesiologists. Hence, the growth of the team is very important to the success of the craniofacial surgeon and ensures safe and effective treatment of the patient.

Chang Gung Forum

“…Regional blocking performed by the anesthetic team, modified Hünsuck osteotomy supplanting Obwegeser osteotomy, the fixation method with a titanium plate and screw, and simultaneous fat grafting with orthognathic surgery, for instance, were presented according to the experiences and innovations of craniofacial professionals. 18 According to Sakamoto and Miwa, 19 craniofacial surgeons who accumulated a certain number of cases and a certain amount of experience had significantly improved surgical outcomes. However, Choudhry et al 20 noted that the decline of factual knowledge worsens with time, and less favorable patient outcomes were found in physicians who had practiced for longer periods.…”

“…According to Sakamoto and Miwa, 19 craniofacial surgeons who accumulated a certain number of cases and a certain amount of experience had significantly improved surgical outcomes. However, Choudhry et al 20 noted that the decline of factual knowledge worsens with time, and less favorable patient outcomes were found in physicians who had practiced for longer periods.…”