Learning curve of tibial cortex transverse transport: a cumulative sum analysis
Abstract Objective This study aimed to describe the learning curve of surgeons performing tibial cortex transverse transport (TTT) and explore its safety and effectiveness during the initial stages of surgeon’s learning. Methods The clinical data of patients with diabetic foot ulcers classified as W...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13018-023-04149-x |
| _version_ | 1797557689984745472 |
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| author | Jun-Peng Liu Xing-Chen Yao Zi-Yu Xu Xin-Ru Du Hui Zhao |
| author_facet | Jun-Peng Liu Xing-Chen Yao Zi-Yu Xu Xin-Ru Du Hui Zhao |
| author_sort | Jun-Peng Liu |
| collection | DOAJ |
| description | Abstract Objective This study aimed to describe the learning curve of surgeons performing tibial cortex transverse transport (TTT) and explore its safety and effectiveness during the initial stages of surgeon’s learning. Methods The clinical data of patients with diabetic foot ulcers classified as Wagner grade ≥ 2, who underwent TTT at our hospital from January 2020 to July 2021, were included in this retrospective analysis. The same physician performed all procedures. Patients were numbered according to the chronological order of their surgery dates. The cumulative sum and piecewise linear regression were used to evaluate the surgeon's learning curve, identify the cut-off point, and divide the patients into learning and mastery groups. A minimum follow-up period of 3 months was ensured for all patients. Baseline data, perioperative parameters, complications, and efficacy evaluation indicators were recorded and compared between the two groups. Results Sixty patients were included in this study based on the inclusion and exclusion criteria. After completing 20 TTT surgeries, the surgeon reached the cut-off point of the learning curve. Compared to the learning group, the mastery group demonstrated a significant reduction in the average duration of the surgical procedure (34.88 min vs. 54.20 min, P < 0.05) along with a notable decrease in intraoperative fluoroscopy (9.75 times vs. 16.9 times, P < 0.05) frequency, while no significant difference was found regarding intraoperative blood loss (P = 0.318). Of the patients, seven (11.7%) experienced complications, with three (15%) and four cases (10%) occurring during the learning phase and the mastery phase, respectively. The postoperative ulcer area was significantly reduced, and the overall healing rate was 94.8%. Significant improvements were observed in postoperative VAS, ABI, and WIFI classification (P < 0.05). There were no significant differences in the occurrence of complications or efficacy indicators between the learning and mastery groups (P > 0.05). Conclusion Surgeons can master TTT after completing approximately 20 procedures. TTT is easy, secure, and highly efficient for treating foot ulcers. Furthermore, TTT’s application by surgeons can achieve almost consistent clinical outcomes in the initial implementation stages, comparable to the mastery phase. |
| first_indexed | 2024-03-10T17:20:12Z |
| format | Article |
| id | doaj.art-55dc484e31d044069ba50aa424a7e3a8 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-03-10T17:20:12Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-55dc484e31d044069ba50aa424a7e3a82023-11-20T10:21:09ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2023-09-0118111110.1186/s13018-023-04149-xLearning curve of tibial cortex transverse transport: a cumulative sum analysisJun-Peng Liu0Xing-Chen Yao1Zi-Yu Xu2Xin-Ru Du3Hui Zhao4Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical UniversityDepartment of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical UniversityDepartment of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical UniversityDepartment of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical UniversityDepartment of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical UniversityAbstract Objective This study aimed to describe the learning curve of surgeons performing tibial cortex transverse transport (TTT) and explore its safety and effectiveness during the initial stages of surgeon’s learning. Methods The clinical data of patients with diabetic foot ulcers classified as Wagner grade ≥ 2, who underwent TTT at our hospital from January 2020 to July 2021, were included in this retrospective analysis. The same physician performed all procedures. Patients were numbered according to the chronological order of their surgery dates. The cumulative sum and piecewise linear regression were used to evaluate the surgeon's learning curve, identify the cut-off point, and divide the patients into learning and mastery groups. A minimum follow-up period of 3 months was ensured for all patients. Baseline data, perioperative parameters, complications, and efficacy evaluation indicators were recorded and compared between the two groups. Results Sixty patients were included in this study based on the inclusion and exclusion criteria. After completing 20 TTT surgeries, the surgeon reached the cut-off point of the learning curve. Compared to the learning group, the mastery group demonstrated a significant reduction in the average duration of the surgical procedure (34.88 min vs. 54.20 min, P < 0.05) along with a notable decrease in intraoperative fluoroscopy (9.75 times vs. 16.9 times, P < 0.05) frequency, while no significant difference was found regarding intraoperative blood loss (P = 0.318). Of the patients, seven (11.7%) experienced complications, with three (15%) and four cases (10%) occurring during the learning phase and the mastery phase, respectively. The postoperative ulcer area was significantly reduced, and the overall healing rate was 94.8%. Significant improvements were observed in postoperative VAS, ABI, and WIFI classification (P < 0.05). There were no significant differences in the occurrence of complications or efficacy indicators between the learning and mastery groups (P > 0.05). Conclusion Surgeons can master TTT after completing approximately 20 procedures. TTT is easy, secure, and highly efficient for treating foot ulcers. Furthermore, TTT’s application by surgeons can achieve almost consistent clinical outcomes in the initial implementation stages, comparable to the mastery phase.https://doi.org/10.1186/s13018-023-04149-xAngiogenesisComplicationDiabetic foot ulcerLearning curveTibial cortex transverse transportUlcer healing |
| spellingShingle | Jun-Peng Liu Xing-Chen Yao Zi-Yu Xu Xin-Ru Du Hui Zhao Learning curve of tibial cortex transverse transport: a cumulative sum analysis Journal of Orthopaedic Surgery and Research Angiogenesis Complication Diabetic foot ulcer Learning curve Tibial cortex transverse transport Ulcer healing |
| title | Learning curve of tibial cortex transverse transport: a cumulative sum analysis |
| title_full | Learning curve of tibial cortex transverse transport: a cumulative sum analysis |
| title_fullStr | Learning curve of tibial cortex transverse transport: a cumulative sum analysis |
| title_full_unstemmed | Learning curve of tibial cortex transverse transport: a cumulative sum analysis |
| title_short | Learning curve of tibial cortex transverse transport: a cumulative sum analysis |
| title_sort | learning curve of tibial cortex transverse transport a cumulative sum analysis |
| topic | Angiogenesis Complication Diabetic foot ulcer Learning curve Tibial cortex transverse transport Ulcer healing |
| url | https://doi.org/10.1186/s13018-023-04149-x |
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