Cumulative sum analysis of the learning curve for endoscopic resection of juvenile nasopharyngeal angiofibroma

Cumulative sum analysis of the learning curve for endoscopic resection of juvenile nasopharyngeal... Background To determine the learning curve with cumulative sum analysis for endoscopic resection of juvenile nasopharyn- geal angiofibroma (JNA) and investigate whether the surgeon’s expertise is a risk factor for recurrence. Materials and methods We reviewed the medical records of patients with JNA who underwent endoscopic or endoscopic- assisted surgery between 2006 and 2015. We used cumulative sum (Cusum) analysis to plot the learning curve for opera- tion time versus chronological sequence, and verified the Cusum curve by risk-adjusted Cusum (RA-Cusum) analysis. We identified three phases of expertise. The recurrence rate was analyzed using the Kaplan–Meier method and log-rank tests. A multivariable Cox regression analysis was performed to identify the independent risk factors for recurrence. Results We included 154 JNA patients with a median age of 16 years. The surgeon overcame the learning curve after case 80 with increasing surgical efficiency and competence. The learning curve plotted by Cusum analysis divided the cases into three phases: phase 1, accumulation of initial experience (cases 1–41); phase 2, further accumulation of experience (cases 42–117); and phase 3, mastering the procedure (cases 118–154). Pearson’s χ tests showed that tumor stage (P = 0.021), blood loss (P = 0.001), operation time (P < 0.001), http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Surgical Endoscopy Springer Journals

Cumulative sum analysis of the learning curve for endoscopic resection of juvenile nasopharyngeal angiofibroma

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Publisher
Springer Journals
Copyright
Copyright © 2018 by Springer Science+Business Media, LLC, part of Springer Nature
Subject
Medicine & Public Health; Surgery; Gynecology; Gastroenterology; Hepatology; Proctology; Abdominal Surgery
ISSN
0930-2794
eISSN
1432-2218
D.O.I.
10.1007/s00464-018-6035-1
Publisher site
See Article on Publisher Site

Abstract

Background To determine the learning curve with cumulative sum analysis for endoscopic resection of juvenile nasopharyn- geal angiofibroma (JNA) and investigate whether the surgeon’s expertise is a risk factor for recurrence. Materials and methods We reviewed the medical records of patients with JNA who underwent endoscopic or endoscopic- assisted surgery between 2006 and 2015. We used cumulative sum (Cusum) analysis to plot the learning curve for opera- tion time versus chronological sequence, and verified the Cusum curve by risk-adjusted Cusum (RA-Cusum) analysis. We identified three phases of expertise. The recurrence rate was analyzed using the Kaplan–Meier method and log-rank tests. A multivariable Cox regression analysis was performed to identify the independent risk factors for recurrence. Results We included 154 JNA patients with a median age of 16 years. The surgeon overcame the learning curve after case 80 with increasing surgical efficiency and competence. The learning curve plotted by Cusum analysis divided the cases into three phases: phase 1, accumulation of initial experience (cases 1–41); phase 2, further accumulation of experience (cases 42–117); and phase 3, mastering the procedure (cases 118–154). Pearson’s χ tests showed that tumor stage (P = 0.021), blood loss (P = 0.001), operation time (P < 0.001),

Journal

Surgical EndoscopySpringer Journals

Published: Jan 24, 2018

References

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