Testa Edward J, Lowe Jeremiah T, Namdari Surena, Gillespie Robert J, Sears Benjamin W, Johnston Peter S, Jawa Andrew
New England Baptist Hospital, Boston, USA.
Tufts University School of Medicine, Boston, USA.
Shoulder Elbow. 2020 Dec;12(1 Suppl):23-30. doi: 10.1177/1758573218811635. Epub 2018 Nov 14.
A surgical learning period may be quantified after which operative duration is significantly reduced. We sought to retrospectively quantify and compare surgeon's learning experience for total shoulder arthroplasty and reverse shoulder arthroplasty.
We reviewed 2055 shoulder arthroplasty cases from 2011 to 2015 for four early-career and four later-career fellowship-trained shoulder surgeons from four institutions. We plotted consecutive case number versus operative time for each surgeon separately for total shoulder arthroplasty or reverse shoulder arthroplasty. Two-step regression approach was used to determine a plateau point or end of the learning period. Additionally, the mean annual volume of reverse shoulder arthroplasty and total shoulder arthroplasty for each surgeon was plotted against mean surgery duration. Early- and later-career surgeons were compared with regression analysis.
Early-career surgeons demonstrated a significant decrease in operative time with increasing annual case volume for reverse shoulder arthroplasty ( = 0.01; = -1.1) and total shoulder arthroplasty ( = 0.02; = -0.8). Three of four early-career surgeons reached a plateau point for either reverse shoulder arthroplasty or total shoulder arthroplasty between 12 and 86 cases.
For only early-career surgeons, higher case volume yields decreased operative duration, with improvement more pronounced for reverse shoulder arthroplasty compared to total shoulder arthroplasty. Though the learning period varies, it may be fewer than 90 cases.
手术学习期可以被量化，在此之后手术时长会显著缩短。我们试图通过回顾性研究来量化并比较外科医生在全肩关节置换术和反式肩关节置换术中的学习经验。
我们回顾了2011年至2015年间来自四个机构的四位早期职业和四位后期职业接受过 fellowship 培训的肩关节外科医生的2055例肩关节置换病例。我们分别针对每位外科医生的全肩关节置换术或反式肩关节置换术，绘制连续病例数与手术时间的关系图。采用两步回归法来确定学习期的平稳点或结束点。此外，还绘制了每位外科医生的反式肩关节置换术和全肩关节置换术的年均手术量与平均手术时长的关系图。通过回归分析对早期和后期职业的外科医生进行比较。
早期职业的外科医生在反式肩关节置换术（P = 0.01；β = -1.1）和全肩关节置换术（P = 0.02；β = -0.8）中，随着年手术量的增加，手术时间显著减少。四位早期职业的外科医生中有三位在12至86例手术之间，达到了反式肩关节置换术或全肩关节置换术的平稳点。
仅对于早期职业的外科医生而言，手术量增加会使手术时长缩短，与全肩关节置换术相比，反式肩关节置换术的改善更为明显。尽管学习期有所不同，但可能少于90例。
