Risk-Adjusted CUSUM Analysis of the Learning Curve of Femtosecond Laser Assisted Cataract Surgery

Roberts, Harry; Wagh, Vijay B; Sung, Justin; Ni, Melody; O’Brart, David

doi:10.1080/02713683.2019.1601742

Cited by 4 publications

(3 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…CUSUM is a statistical tool, which is increasingly used to objectively evaluate the learning curves of surgical techniques [11][12][13][14][15][16][17][18][19][20][21]. It enables us to quantitatively compare two surgical methods (in this case, ELA vs. MMCR) using statistical process control method depending on consecutive operations [16,17].…”

Section: Discussionmentioning

confidence: 99%

“…However, more objective analytic methods are required when comparing two different surgical techniques. Therefore, the cumulative sum (CUSUM) analysis has been developed to assess the learning curves of surgical procedures and is accepted in ophthalmology and many surgical fields [11][12][13][14][15][16][17]. CUSUM analysis, which is a statistical process control method, provides an objective and quantitative evaluation of surgical learning curves [11][12][13][14][15][16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cumulative Sum Analysis of the Learning Curve of Ptosis Surgery: External Levator Advancement versus Müller Muscle-conjunctival Resection

Mangan

Çakir

İmamoğlu

2021

Korean J Ophthalmol

View full text Add to dashboard Cite

Purpose: Even though it is stated that external levator advancement (ELA) has a much longer learning curve than Müller muscle-conjunctival resection (MMCR) in the treatment of aponeurotic ptosis, there is no study in the literature regarding the learning curves of these two surgical techniques. We aimed to objectively determine the length of the learning curves of ELA and MMCR using cumulative sum (CUSUM) analysis.Methods: The first 30 unilateral ELA and the first 30 unilateral MMCR consecutively performed by a single surgeon were retrospectively reviewed. The CUSUM method was used to analyze the learning curves of ELA and MMCR based on operation times of consecutive surgeries and the clinical outcomes were compared.Results: CUSUM analyses revealed that the operation time stabilized after around 11 ELA surgeries and 12 MMCR surgeries and R2 value for ELA and MMCR were 0.93 and 0.91, respectively. There was no significant difference in these stratified analyses. Mean operation time was 45.7 minutes in the ELA group and 34.1 minutes in the MMCR group (p = 0.002). Total number of intraoperative complications was 37 in the ELA group and 16 in the MMCR group (p = 0.015). Symmetry success rate was significantly higher (p < 0.0001) and reoperation rate was significantly lower in the MMCR group (p = 0.045).Conclusions: Even though ELA is more challenging than MMCR, comparable learning curves indicate that surgeons in training need to be encouraged to perform both techniques. The challenges and obstacles that the surgeons in training face in these two techniques need to be analyzed in detail.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cumulative Sum Analysis of the Learning Curve of Ptosis Surgery: External Levator Advancement versus Müller Muscle-conjunctival Resection

Mangan

Çakir

İmamoğlu

2021

Korean J Ophthalmol

View full text Add to dashboard Cite

show abstract

“…23 Recently, there are several kinds of literature published on the study of FLACS's learning curve; however, the length of the learning curve is still uncertain. 24 Also, a prospective cohort study with a large sample that provides a comprehensive and systematic analysis of all possible intraoperative complications of FLACS has not been conducted yet, especially in Asian patients. In this study, we conducted a comprehensive and in-depth investigation of the incidence of all possible intraoperative complications using the LenSx laser system (Alcon LenSx, Inc, Aliso Viejo, California, USA) in a large cohort of Chinese patients undergoing FLACS.…”

Section: Lens and Cataractmentioning

confidence: 99%

Incidence and analysis of intraoperative complications in femtosecond laser-assisted cataract surgery: a large-scale cohort study to establish the learning curve

Zhang,

Xu,

Shentu

et al. 2024

Br J Ophthalmol

View full text Add to dashboard Cite

AimsTo assess the safety of femtosecond laser-assisted cataract surgery (FLACS) based on surgical parameters and intraoperative complications analysis and to determine the length of the learning curve for FLACS.MethodsA prospective consecutive cohort study was conducted on Chinese patients who underwent either FLACS (3289 cases) or contemporaneous conventional phacoemulsification cataract surgery (2130 cases). The laser group was divided into four subgroups in chronological order. We recorded intraoperative complication incidences and compared with surgical parameters between groups. Subgroup analysis was conducted to explore the learning curve of FLACS.ResultsThe laser group had a 4.93% incidence of incomplete capsulotomies and a 1.22% incidence of anterior capsule tears. Subgroup analysis showed significant differences in 8 aspects between the first 250 cases (50 cases per surgeon) and the last 2539 cases, but only 2 aspects differed between the second 250 cases (50 cases per surgeon) and the last 2539 cases. There were no significant differences between the third 250 cases (50 cases per surgeon) and the last 2539 cases.ConclusionsThe intraoperative complications of FLACS were reported, and the learning curve is associated with a significant reduction in the incidence of intraoperative complications. The length of the basic learning curve of FLACS is 100 cases, and the length of the advanced learning curve was 150 cases. This study demonstrated that FLACS is characterised by a relatively straightforward and secure operative technique.

show abstract

Lens capsule-related complications in femtosecond laser-assisted cataract surgery: a study based on video analysis

et al. 2022

View full text Add to dashboard Cite

PurposeTo analyse the occurrence and potential causes of lens capsule-related complications during femtosecond laser-assisted cataract surgery (FLACS).MethodsThis prospective consecutive cohort study included the first 1600 eyes (from 1140 consecutive patients) who received FLACS performed by the same surgeon from May 2015 to December 2018. The potential causes and characteristic signs of capsulotomy-related complications, including incomplete capsulotomies and radial anterior capsule (AC) tears, were summarised based on the agreement of two ophthalmologists after they analysed the surgical videos. Subgroup analysis was conducted to characterise the capsulotomy learning curve.ResultsOf the 1600 eyes, 52 (3.25%) had incomplete capsulotomies and 22 (1.38%) had radial AC tears. The most common causes of incomplete capsulotomies were eye tilt (16 eyes, 30.77%), air bubbles or ocular secretions at the interface (14 eyes, 26.92%) and white cataracts (7 eyes, 13.46%). Additionally, 54.55% (12/22) of AC tears were due to incomplete capsulotomy and secondary capsulorhexis. A significant difference was noted between the first 200 eyes and subsequent groups in terms of the incidence of incomplete capsulotomies. No difference was observed in the incidence of AC tears after the initial 100 procedures.ConclusionThe most common causes of incomplete capsulotomies were eye tilt and air bubbles or ocular secretions at the interface. Secondary capsulorhexis after incomplete capsulotomy is the main risk factor for AC tears. There was a steep learning curve for laser capsulotomy in the first 100 operated eyes, as evidenced by the higher complication rate, but this stabilised after 200 procedures.

show abstract

Risk-Adjusted CUSUM Analysis of the Learning Curve of Femtosecond Laser Assisted Cataract Surgery

Cited by 4 publications

References 30 publications

Cumulative Sum Analysis of the Learning Curve of Ptosis Surgery: External Levator Advancement versus Müller Muscle-conjunctival Resection

Cumulative Sum Analysis of the Learning Curve of Ptosis Surgery: External Levator Advancement versus Müller Muscle-conjunctival Resection

Incidence and analysis of intraoperative complications in femtosecond laser-assisted cataract surgery: a large-scale cohort study to establish the learning curve

Lens capsule-related complications in femtosecond laser-assisted cataract surgery: a study based on video analysis

Contact Info

Product

Resources

About