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Learning curve analyses in spine surgery: a systematic simulation-based critique of methodologies
Conor McNamee1, Salman Keraidi1, Jake McDonnell2
1National Spine Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland; University College Dublin School of Medicine, Dublin, Ireland.
This study critically evaluates spine surgery learning curve methodologies, finding cumulative summation (CUSUM) analyses most reliable when correctly applied. Future research requires methodological guidelines and multiple performance metrics for valid, comparable learning curve assessments.
Area of Science:
- Spine surgery outcomes research
- Surgical education and training
- Medical data analysis
Background:
- Existing statistical methods for spine surgery learning curves, such as interval comparison, regression, and cumulative summation (CUSUM) analyses, exhibit inconsistencies and methodological flaws.
- These limitations hinder the comparability and reliability of current learning curve assessments in spine surgery literature.
Purpose of the Study:
- To critically evaluate the methodologies employed in existing spine surgery learning curve literature.
- To provide evidence-based recommendations for enhancing the quality and consistency of future research in this field.
Main Methods:
- Systematic literature review of PubMed, Embase, and Scopus (January 2010–September 2023).
- Inclusion criteria focused on studies evaluating individual surgeon performance change over time in human spine surgery.
- Simulated surgical data analyzed using interval division, regression, and CUSUM techniques; risk of bias assessed with ROBINS-I tool.
Main Results:
- 113 studies met inclusion criteria; most were retrospective, single-surgeon focused.
- Operating time was the most frequent metric; interval division was common but limited for synthesis.
- Regression analysis effectiveness depended on sample size and model choice; CUSUM analyses varied in quality, with correct application offering reliable insights.
Conclusions:
- Significant variation exists in the quality of spine surgery learning curve studies.
- Correctly applied cumulative summation (CUSUM) analyses provide the most dependable learning curve estimations.
- Future studies necessitate adherence to methodological guidelines, use of multiple performance metrics, and composite measures for robust learning curve evaluation.
