Wu Xianqiu, Wei Wuli, He Yi, Qin Huajing, Qi Fenqiang
Department of Cardio-Thoracic Surgery, the Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou 545005, China.
The Medical Records and Statistics Room, the Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou 545005, China.
Heart Lung Circ. 2019 Mar;28(3):471-476. doi: 10.1016/j.hlc.2018.02.002. Epub 2018 Feb 14.
To apply the cumulative sum (CUSUM) failure analysis to assess the performance of a single surgeon during mitral valve replacement via the right anterolateral minithoracotomy (RAMT) approach and to analyse the learning curve for the procedure.
A total of 100 mitral valve replacements were performed using the RAMT approach from June 2011 to April 2013 by a single surgeon with no prior experience of this technique. Patients were divided into five blocks according to the operation date. The perioperative data were collected prospectively and analysed using descriptive statistics and CUSUM failure analysis.
No significant differences in the background factors among the five periods were observed, except for a small increase in patient age from periods 1 to 5 (p=0.004). The surgeon's performance improved with time; a decrease in the cross-clamp time, operative time, and blood loss was observed (p<0.001). However, no significant difference in the number of failed cases was observed among the periods. All failure cases were evaluated by the CUSUM failure analysis and the CUSUM curve reflected a learning curve associated with this new procedure. The surgeon crossed the lower 80% boundary after about 33 operations, which indicates that better results can be obtained after this point.
Minimally invasive mitral valve surgery using the RAMT approach can be performed by a new surgeon. Furthermore, CUSUM curve analysis is a simple statistical method to implement continuous individual performance monitoring.
应用累积和（CUSUM）失效分析评估单名外科医生经右前外侧小切口（RAMT）入路进行二尖瓣置换术的手术表现，并分析该手术的学习曲线。
2011年6月至2013年4月，一名此前无该技术经验的外科医生采用RAMT入路共进行了100例二尖瓣置换术。根据手术日期将患者分为五个组。前瞻性收集围手术期数据，并采用描述性统计和CUSUM失效分析进行分析。
除第1组至第5组患者年龄略有增加（p = 0.004）外，五个时期的背景因素未见显著差异。外科医生的手术表现随时间改善；观察到主动脉阻断时间、手术时间和失血量减少（p < 0.001）。然而，各时期失败病例数未见显著差异。所有失败病例均通过CUSUM失效分析进行评估，CUSUM曲线反映了与该新手术相关的学习曲线。外科医生在约33例手术后越过了较低的80%界限，这表明此后可获得更好的结果。
新外科医生可采用RAMT入路进行微创二尖瓣手术。此外，CUSUM曲线分析是一种用于持续个体手术表现监测的简单统计方法。
