Identificador: TDX:2951
Autors: Martín Avià, Jordi
Resum:
Introduction: There is no method for learning curve assessment in vitrectomy, the most common being the sequential case analysis of surgical complications. There are no tutorized retina fellowships in Spain, so it is necessary to develop a self-assessment system of the vitrectomy learning curve, to ensure safe progress until it is achieved.
Objective: To assess cumulative sum analysis (CUSUM) capability to analyze learning curve in vitrectomy.
Methods: A single ophthalmologist trainee’s first vitrectomy cases were evaluated. Following data was collected: diagnosis, learning time, surgical technique, intraoperative and postoperative complications. Sequential case analysis was carried out to assess the evolution of surgical complications over time and CUSUM charts were created for 5 variables: retinotomy, ocular hypertension, hypotony, secondary cataract and retinal redetachment.
Results: 237 vitrectomies were included. Sequential case analysis detected a change in surgical technique towards transconjunctival vitrectomy around the 80th case, with surgical complications increasing in the following trimester. CUSUM charts show good performances, achieving competence at a different learning time for each variable, as well as periods of an unsatisfactory performance, coincident with an increase in surgical complications. Full vitrectomy competence was achieved following 236 procedures.
Conclusions: Learning curve analysis indicates that time to achieve competence takes longer than the surgical trainee thinks. Sequential case analysis is proved to be a subjective and late system for learning curve assessment, while CUSUM analysis is proposed as an objective, prospective and precise method, that also provides the ability to anticipate an unsatisfactory performance.
Repositori URV