Learning curve in off-pump coronary artery bypass graft surgery in a low-income country: a single-center experience

Off-pump coronary artery bypass grafting (CABG) remains technically demanding, especially in low-income settings. Understanding the surgical learning curve is crucial for optimizing outcomes, training, and resource utilization.

This study aimed to evaluate the surgical learning curve for off-pump coronary artery bypass grafting (CABG) using cumulative sum (CUSUM) analysis. We conducted a retrospective analysis of 49 patients who underwent isolated CABG. Key performance indicators, including operation time, number of anastomoses, ventilation duration, ICU stay, and postoperative hospitalization, were assessed to identify performance trends and a transition point reflecting surgical proficiency.

A transition point in the cumulative sum (CUSUM) chart was observed in Case 28. The mean operation time decreased from 267.1 min pre-transition to 180.7 min post-transition. Other improvements included ventilation time (from 10.66 to 6.52 h), ICU time (from 42.34 to 22.57 h), and postoperative hospitalization (from 12.44 to 9.24 days). The number of anastomoses remained consistent throughout the study period.

CUSUM analysis effectively identified the performance improvement phases. The operation time and perioperative parameters improved after the transition point, reflecting a positive learning curve.