Abstract
ABSTRACT Objective: To describe the learning curve that shows the progress of a single neurosurgeon when performing single-level MI-TLIF. Methods: We included 99 consecutive patients who underwent single-level MI-TLIF by the same neurosurgeon (JASS). Patient’s demographic characteristics were analyzed. In addition, surgical time, intraoperative blood loss and hospital stay were evaluated. The learning curves were calculated with a piecewise regression model. Results: The mean age was 54.6 years. The learning curves showed an inverse relationship between the surgical experience and the variable analyzed, reaching an inflection point for surgical time in case 43 and for blood loss in case 48. The mean surgical time was 203.3 minutes (interquartile range [IQR] 150-240 minutes), intraoperative bleeding was 97.4ml (IQR 40-100ml) and hospital stay of four days (IQR 3-5 days). Conclusions: MI-TLIF is a very frequent surgical procedure due to its effectiveness and safety, which has shown similar results to open procedure. According to this study, the required learning curve is slightly higher than for open procedures, and is reached after about 45 cases.
Highlights
When a new procedure is being learned, performance tends to improve with experience; in medicine there are no accurate measurements to monitor said improvement
To be able to measure learning in a surgical procedure, the procedural factors and those related to patient outcome can be evaluated
We evaluated various parameters, such as surgical time, amount of bleeding, and days of hospitalization
Summary
When a new procedure is being learned, performance tends to improve with experience; in medicine there are no accurate measurements to monitor said improvement. This is why learning curves have been adopted, first described in 1936 by TP Wright, an aeronautical engineer, and widely used in industry where performance measurement is very clear. Mortality is not a good factor in the evaluation of procedures with a low risk of mortality.[1]
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