Outcomes in Stapedotomy Surgery: The Learning Curve Redefined

Area of Science:

• Otolaryngology
• Surgical Education
• Medical Statistics

Background:

• Assessing surgeon proficiency in stapes surgery is crucial for patient outcomes.
• Traditional benchmarks for surgical competence may not fully capture the nuances of skill acquisition and maintenance.

Purpose of the Study:

• To evaluate the utility of the cumulative summation test for the learning curve (LC-CUSUM) and cumulative summation graph (CUSUM) in demonstrating competence and proficiency maintenance in stapes surgery.
• To explore the effectiveness of these statistical tools in analyzing surgical performance over a continuous period.

Main Methods:

• Retrospective review of 204 primary and revision stapedotomies performed between January 1999 and August 2014 at a tertiary referral hospital.
• Learning curves were constructed using LC-CUSUM and CUSUM, with failure defined as closure of the air-bone gap (ABG) greater than 15 dB.

Main Results:

• Using a failure definition of ABG closure >10 dB did not yield useful LC-CUSUM and CUSUM graphs.
• Redefining failure as ABG closure >15 dB allowed for the identification of a competency landmark at case 43.
• Proficiency maintenance was observed, with natural fluctuations noted between cases 137-149 and at case 196.

Conclusions:

• LC-CUSUM and CUSUM provide a robust method for illustrating surgical learning curves in stapes surgery.
• The traditional benchmark of ABG closure ≤10 dB in >90% of patients may require re-evaluation.
• These methods serve as standardized audit tools for monitoring surgical results and planning training programs, clearly defining when trainees achieve competence.