Cumulative sum learning curve analysis of tubularized incised plate repair for hypospadias: a study of a single surgeon with a single surgical procedure
PurposeTo ascertain the quantity of instances by which a single surgeon achieves competency and proficiency in using tubularized incised plate (TIP) technique for the repair of distal and mid-shaft hypospadias using the cumulative sum (CUSUM) analysis.MethodsWe retrospectively evaluated patients wit...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-04-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2024.1375345/full |
| _version_ | 1797214787694755840 |
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| author | Jiaqiang Li Jiaqian Zhang Hongwang Diao Zhuoyuan He Shoulin Li Jianchun Yin |
| author_facet | Jiaqiang Li Jiaqian Zhang Hongwang Diao Zhuoyuan He Shoulin Li Jianchun Yin |
| author_sort | Jiaqiang Li |
| collection | DOAJ |
| description | PurposeTo ascertain the quantity of instances by which a single surgeon achieves competency and proficiency in using tubularized incised plate (TIP) technique for the repair of distal and mid-shaft hypospadias using the cumulative sum (CUSUM) analysis.MethodsWe retrospectively evaluated patients with distal and mid-shaft hypospadias who were treated by a single surgeon between 2015 and 2021, using a single primary TIP technique with a de-epithelialized Byars flap. Data including type of hypospadias, age at surgery, curvature, operation time (OT), length of the reconstructed urethra, and postoperative outcomes were collected and assessed. CUSUM was used to assess the trends in OT and complication rate (CR) in order to generate the learning curve. The evolution of OT and CR can be divided into three phases: learning, competence, and proficiency.ResultsCUSUM identified three phases in the learning curves of all TIP repairs. The median OT decreased from 135 min [interquartile range (IQR) = 125–155] to 92 min (IQR = 80–100) (P < 0.001), CR decreased from 28 (28%) to 8 (5.3%) (P < 0.001), and reoperations decreased from 15 (15.2%) to 4 (2.6%) (P < 0.001). According to the CUSUM learning curve, technical competency plateaued after the 99th case, and both OT and CR entered a significantly declining proficiency phase after the 231st case. Further, when the neourethral length exceeded the total average, total complications, urethrocutaneous fistula, and reoperations increased (P = 0.013, P = 0.006, and P = 0.028, respectively).ConclusionsOur study suggests that surgeons performing TIP repair may reach technical competency and achieve proficiency after operating on 99,231 cases, respectively. Moreover, the longer the neourethral length, the higher is the CR. |
| first_indexed | 2024-04-24T11:19:44Z |
| format | Article |
| id | doaj.art-e0cc2f798bf84f1193c9903c6d363f4a |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-04-24T11:19:44Z |
| publishDate | 2024-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-e0cc2f798bf84f1193c9903c6d363f4a2024-04-11T04:53:49ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602024-04-011210.3389/fped.2024.13753451375345Cumulative sum learning curve analysis of tubularized incised plate repair for hypospadias: a study of a single surgeon with a single surgical procedureJiaqiang LiJiaqian ZhangHongwang DiaoZhuoyuan HeShoulin LiJianchun YinPurposeTo ascertain the quantity of instances by which a single surgeon achieves competency and proficiency in using tubularized incised plate (TIP) technique for the repair of distal and mid-shaft hypospadias using the cumulative sum (CUSUM) analysis.MethodsWe retrospectively evaluated patients with distal and mid-shaft hypospadias who were treated by a single surgeon between 2015 and 2021, using a single primary TIP technique with a de-epithelialized Byars flap. Data including type of hypospadias, age at surgery, curvature, operation time (OT), length of the reconstructed urethra, and postoperative outcomes were collected and assessed. CUSUM was used to assess the trends in OT and complication rate (CR) in order to generate the learning curve. The evolution of OT and CR can be divided into three phases: learning, competence, and proficiency.ResultsCUSUM identified three phases in the learning curves of all TIP repairs. The median OT decreased from 135 min [interquartile range (IQR) = 125–155] to 92 min (IQR = 80–100) (P < 0.001), CR decreased from 28 (28%) to 8 (5.3%) (P < 0.001), and reoperations decreased from 15 (15.2%) to 4 (2.6%) (P < 0.001). According to the CUSUM learning curve, technical competency plateaued after the 99th case, and both OT and CR entered a significantly declining proficiency phase after the 231st case. Further, when the neourethral length exceeded the total average, total complications, urethrocutaneous fistula, and reoperations increased (P = 0.013, P = 0.006, and P = 0.028, respectively).ConclusionsOur study suggests that surgeons performing TIP repair may reach technical competency and achieve proficiency after operating on 99,231 cases, respectively. Moreover, the longer the neourethral length, the higher is the CR.https://www.frontiersin.org/articles/10.3389/fped.2024.1375345/fullhypospadiastubularized incised plateclinical competenceproficiencycumulative sum analysis of learning curve |
| spellingShingle | Jiaqiang Li Jiaqian Zhang Hongwang Diao Zhuoyuan He Shoulin Li Jianchun Yin Cumulative sum learning curve analysis of tubularized incised plate repair for hypospadias: a study of a single surgeon with a single surgical procedure Frontiers in Pediatrics hypospadias tubularized incised plate clinical competence proficiency cumulative sum analysis of learning curve |
| title | Cumulative sum learning curve analysis of tubularized incised plate repair for hypospadias: a study of a single surgeon with a single surgical procedure |
| title_full | Cumulative sum learning curve analysis of tubularized incised plate repair for hypospadias: a study of a single surgeon with a single surgical procedure |
| title_fullStr | Cumulative sum learning curve analysis of tubularized incised plate repair for hypospadias: a study of a single surgeon with a single surgical procedure |
| title_full_unstemmed | Cumulative sum learning curve analysis of tubularized incised plate repair for hypospadias: a study of a single surgeon with a single surgical procedure |
| title_short | Cumulative sum learning curve analysis of tubularized incised plate repair for hypospadias: a study of a single surgeon with a single surgical procedure |
| title_sort | cumulative sum learning curve analysis of tubularized incised plate repair for hypospadias a study of a single surgeon with a single surgical procedure |
| topic | hypospadias tubularized incised plate clinical competence proficiency cumulative sum analysis of learning curve |
| url | https://www.frontiersin.org/articles/10.3389/fped.2024.1375345/full |
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