Learning curve evaluation using cumulative summation analysis-a clinical example of pediatric robot-assisted laparoscopic pyeloplasty
Learning curve evaluation using cumulative summation analysis-a clinical example of pediatric robot-assisted laparoscopic pyeloplasty
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DOI：
10.1016/j.jpedsurg.2014.12.025
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发表时间：
2015-08-01
影响因子：
2.4
通讯作者：
Najmaldin, Azad S.
中科院分区：
文献类型：
--
作者：
Cundy, Thomas P.;Gattas, Nicholas E.;Najmaldin, Azad S.
背景资料：用于学习曲线分析的累积求和（CANUUM）方法在外科文献中的应用普遍不足，仅在小儿外科领域的少数出版物中进行了描述。本研究介绍了APPLICAUM分析技术，并将其应用于评估小儿机器人辅助腹腔镜肾盂成形术（RP）的学习曲线。方法：前瞻性地记录了由一名外科医生进行的连续小儿RP病例的临床数据。针对设置时间、对接时间、控制台时间、手术时间、手术室总时间和术后并发症生成了CANUUM图表和测试。转换和可避免的手术室延迟分别进行了评价方面的情况下的经验。病例经验和基于时间的结果之间的比较分别使用Student t检验和ANOVA对双相和多相学习曲线进行评估。使用Kruskal-Wallis检验评估病例经验和并发症发生率之间的比较。在病例10、15、42、57和58，学习曲线分别在设置时间、对接时间、控制台时间、手术时间和总手术室时间方面过渡到学习阶段之外。学习阶段和后续阶段之间平均操作时间的所有比较均具有统计学意义（P =
Background: The cumulative summation (CUSUM) method for learning curve analysis remains under-utilized in the surgical literature in general, and is described in only a small number of publications within the field of pediatric surgery. This study introduces the CUSUM analysis technique and applies it to evaluate the learning curve for pediatric robot-assisted laparoscopic pyeloplasty (RP).Methods: Clinical data were prospectively recorded for consecutive pediatric RP cases performed by a single-surgeon. CUSUM charts and tests were generated for set-up time, docking time, console time, operating time, total operating room time, and postoperative complications. Conversions and avoidable operating room delay were separately evaluated with respect to case experience. Comparisons between case experience and time-based outcomes were assessed using the Student's t-test and ANOVA for bi-phasic and multi-phasic learning curves respectively. Comparison between case experience and complication frequency was assessed using the Kruskal-Wallis test.Results: A total of 90 RP cases were evaluated. The learning curve transitioned beyond the learning phase at cases 10, 15, 42, 57, and 58 for set-up time, docking time, console time, operating time, and total operating room time respectively. All comparisons of mean operating times between the learning phase and subsequent phases were statistically significant (P =