Cumulative Sum Analysis of the Learning Curve of Free Flap Reconstruction in Head and Neck Cancer Patients
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Objectives. Owing to the functional and structural complexity of the head and neck area, the reconstruction of defects in these areas is challenging. Free flap surgery has become standard for the reconstruction of the head and neck with improvements in microvascular surgery. The aim of this study was to use the cumulative sum (CUSUM) method to evaluate the learning curve for free-flap head and neck reconstruction performed by a single surgeon. Methods. We retrospectively reviewed the medical records of 47 patients who underwent free-flap reconstruction from 2017 to 2021. The clinical demographics and surgical outcomes were analyzed. The total operation time was analyzed using the CUSUM method, which is an analytical approach for visualizing patterns in data by converting raw data into an accumulation of deviations from the average value. Results. CUSUM analysis showed two phases of the learning curve: phase 1 (cases 1–22) and phase 2 (cases 23–47). The operative time in phase 1 (579.9±128.2 minutes) was significantly longer than that in phase 2 (418.6±80.9 minutes) (P
Abstract
Objectives. Owing to the functional and structural complexity of the head and neck area, the reconstruction of defects in these areas is challenging. Free flap surgery has become standard for the reconstruction of the head and neck with improvements in microvascular surgery. The aim of this study was to use the cumulative sum (CUSUM) method to evaluate the learning curve for free-flap head and neck reconstruction performed by a single surgeon. Methods. We retrospectively reviewed the medical records of 47 patients who underwent free-flap reconstruction from 2017 to 2021. The clinical demographics and surgical outcomes were analyzed. The total operation time was analyzed using the CUSUM method, which is an analytical approach for visualizing patterns in data by converting raw data into an accumulation of deviations from the average value. Results. CUSUM analysis showed two phases of the learning curve: phase 1 (cases 1–22) and phase 2 (cases 23–47). The operative time in phase 1 (579.9±128.2 minutes) was significantly longer than that in phase 2 (418.6±80.9 minutes) (P
참고문헌 (27)
- 김희진, "Results of Free Flap Reconstruction After Ablative Surgery in the Head and Neck", Clinical and Experimental Otorhinolaryngology, 8(2), pp.167~173 (2015), 대한이비인후과학회[DOI]
- Hurvitz KA, "Current options in head and neck reconstruction", Plast Reconstr Surg, 118(5), pp.122e~133e (2006)
- Urken ML, "Microvascular free flaps in head and neck reconstruction : report of 200 cases and review of complications", Arch Otolaryngol Head Neck Surg, 120(6), pp.633~640 (1994)
- Watkinson JC, "Free flaps in head and neck reconstructive surgery : a review of 77 cases", Clin Otolaryngol Allied Sci, 16(4), pp.350~353 (1991)
- Godina M, "Early microsurgical reconstruction of complex trauma of the extremities", Plast Reconstr Surg, 78(3), pp.285~292 (1986)
- Barnard GA, "Control charts and stochastic processes", J R Stat Soc Series B Stat Methodol, 21(2), pp.239~271 (1959)
- Steiner SH, "Monitoring surgical performance using risk-adjusted cumulative sum charts", Biostatistics, 1(4), pp.441~452 (2000)
- de Leval MR, "Analysis of a cluster of surgical failures. Application to a series of neonatal arterial switch operations", J Thorac Cardiovasc Surg, 107(3), pp.914~923 (1994)
- Steiner SH, "Monitoring paired binary surgical outcomes using cumulative sum charts", Stat Med, 18(1), pp.69~86 (1999)
- Bokhari MB, "Learning curve for robotic-assisted laparoscopic colorectal surgery", Surg Endosc, 25(3), pp.855~860 (2011)
- Park EJ, "Long-term oncologic outcomes of laparoscopic right hemicolectomy during the learning curve period : comparative study with cases after the learning curve period", Surg Laparosc Endosc Percutan Tech, 25(1), pp.52~58 (2015)
- Tekkis PP, "Evaluation of the learning curve in ileal pouch-anal anastomosis surgery", Ann Surg, 241(2), pp.262~268 (2005)
- 허성재, "Learning Curve of Septoplasty with Radiofrequency Volume Reduction of the Inferior Turbinate", Clinical and Experimental Otorhinolaryngology, 6(4), pp.231~236 (2013), 대한이비인후과학회[DOI]
- 반명진, "Externally Monitored Versus Conventional Buried Flaps in Laryngopharyngeal Reconstruction", Clinical and Experimental Otorhinolaryngology, 14(4), pp.407~413 (2021), 대한이비인후과학회[DOI]
- Khouri RK, "Avoiding free flap failure", Clin Plast Surg, 19(4), pp.773~781 (1992)
- Blackwell KE, "Overcoming the learning curve in microvascular head and neck reconstruction", Arch Otolaryngol Head Neck Surg, 123(12), pp.1332~1335 (1997)
- Demir A, "The effect of learning curve on flap selection, re-exploration, and salvage rates in free flaps : a retrospective analysis of 155 cases", Microsurgery, 33(7), pp.519~526 (2013)
- Klosterman T, "Free flap reconstruction experience and outcomes at a low-volume institution over 20 years", Otolaryngol Head Neck Surg, 152(5), pp.832~837 (2015)
- Ratnagiri R, "Reconstruction in head-and-neck cancers : analysis of the learning curve", Natl J Maxillofac Surg, 9(2), pp.191~195 (2018)
- Chaput de Saintonge DM, "Why don’t doctors use cusums?", Lancet, 1(7848), pp.120~121 (1974)
- Wohl H, "The cusum plot : its utility in the analysis of clinical data", N Engl J Med, 296(18), pp.1044~1045 (1977)
- Ariyan S, "Myocutaneous flaps for head and neck reconstruction", Head Neck Surg, 2(4), pp.321~345 (1980)
- Yang GF, "Forearm free skin flap transplantation: a report of 56 cases. 1981", Br J Plast Surg, 50(3), pp.162~165 (1997)
- Song YG, "The free thigh flap : a new free flap concept based on the septocutaneous artery", Br J Plast Surg, 37(2), pp.149~159 (1984)
- 박준욱, "Survival Benefits From Surgery for Stage IVa Head and Neck Squamous Cell Carcinoma: A Multi-institutional Analysis of 1,033 Cases", Clinical and Experimental Otorhinolaryngology, 14(2), pp.225~234 (2021), 대한이비인후과학회[DOI]
- Classen DA, "Complications in a consecutive series of 250 free flap operations", Ann Plast Surg, 56(5), pp.557~561 (2006)
- Harashina T, "Analysis of 200 free flaps", Br J Plast Surg, 41(1), pp.33~36 (1988)