Sequential Hypothesis Testing to Characterise the Learning Curve and Monitor Surgical Performance in Retinal Detachment Surgery

Keller, Johannes; Haynes, Richard; Sparrow, J M

doi:10.1159/000443749

Cited by 7 publications

(7 citation statements)

References 13 publications

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“…On the other hand, even for the first cases in beginners, acceptable success rates were reported [ 3 ]. Keller concluded that the first 100 RD operations were crucial when monitoring the learning curve of surgical performance [ 4 ]. Sagong suggested that only 30 cases were necessary to reach stable success rates in buckle surgery [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

The learning curve of retinal detachment surgery

Radeck

Helbig

Barth

et al. 2021

Graefes Arch Clin Exp Ophthalmol

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Purpose To investigate the learning curve of vitreoretinal (VR) surgeons beginning training in retinal detachment (RD) surgery. Methods The files of all consecutive patients undergoing VR surgery for uncomplicated RD between Jan 2005 und Mar 2020 were retrospectively reviewed. Successful outcome was defined as no retinal redetachment within 3 months after surgery. Results Ten surgeons started their VR career during this period. Together, these 10 surgeons performed 3786 RD operations (mean 379; median 251; range 71–1053). Primary success rate after one operation was 90% (3420 of 3786). When starting to operate retinal detachments, VR surgeons had a primary success rate of about 80%. Redetachment rates steadily decreased and stabilized at just under 10% after about 200 operations. Beginners needed more than twice the time for the procedure compared to experienced surgeons. The individual learning curves varied widely. In our series, female surgeons seem to have a faster learning curve. Conclusion RD surgery performed by VR surgeons in training had acceptable results. With increasing experience, success rates continuously improve reaching stable levels after approximately 200 operations. The training of VR surgeons requires considerable resources.

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Section: Discussionmentioning

confidence: 99%

The learning curve of retinal detachment surgery

Radeck

Helbig

Barth

et al. 2021

Graefes Arch Clin Exp Ophthalmol

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“…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%

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

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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.

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“…Other studies have shown comparable results in PPV for RRD between experienced and inexperienced surgeons [25][26][27][28][29][30]. Ehrlich et al and Dugas et al [25,26] compared the success rates of sutureless PPV for RRD between experienced and inexperienced surgeons and used similar exclusion and inclusion criteria as our study.…”

Section: Discussionmentioning

confidence: 52%

25-gauge vitrectomy with gas tamponade for rhegmatogenous retinal detachment: experienced vs. inexperienced surgeons

Pencak

Veith

Stranak

et al. 2020

Preprint

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Background: To compare the results and complication rates of a 25-gauge pars plana vitrectomy (25 g PPV) with gas tamponade for rhegmatogenous retinal detachment (RRD) between experienced and inexperienced surgeons.Methods: This is a retrospective comparative consecutive case series study of patients with uncomplicated RRD treated with 25 g PPV with gas tamponade. Patients were divided into 2 groups: In Group 1 (ESG) the procedure was performed by an experienced vitreoretinal surgeon and in Group 2 (ISG) the procedure was performed by 2 inexperienced surgeons. Anatomical and functional results and complication rates were compared between the two groups.Results: 216 eyes were included in the study. In the ESG (106 eyes), the single operation success rate was 94.3%, and the final success rate was 100%. The mean best-corrected visual acuity (BCVA) improved from 0.38 decimal to 0.73 decimal. In the ISG (110 eyes), the single operation success rate was 93.6%, and the final success rate was 100.0%. The mean BCVA improved from 0.33 decimal to 0.74 decimal. The differences between groups were not statistically significant. There was no difference in complication rates between groups.Conclusions: A 25 g PPV with gas tamponade for uncomplicated RRD renders excellent functional and anatomical results even when performed by an inexperienced surgeon. The complication rate was comparable between experienced and inexperienced surgeons.

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Sequential Hypothesis Testing to Characterise the Learning Curve and Monitor Surgical Performance in Retinal Detachment Surgery

Cited by 7 publications

References 13 publications

The learning curve of retinal detachment surgery

The learning curve of retinal detachment surgery

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

25-gauge vitrectomy with gas tamponade for rhegmatogenous retinal detachment: experienced vs. inexperienced surgeons

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