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Cumulative Sum Analysis of the Learning Curve of Free Flap Reconstruction in Head and Neck Cancer Patients

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 wa...

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Autores principales: Han, Seung Hoon, Kim, Young Chul, Kwon, Tack-Kyun, Lee, Doh Young
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Otorhinolaryngology-Head and Neck Surgery 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9149234/
https://www.ncbi.nlm.nih.gov/pubmed/35249319
http://dx.doi.org/10.21053/ceo.2021.01053
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author Han, Seung Hoon
Kim, Young Chul
Kwon, Tack-Kyun
Lee, Doh Young
author_facet Han, Seung Hoon
Kim, Young Chul
Kwon, Tack-Kyun
Lee, Doh Young
author_sort Han, Seung Hoon
collection PubMed
description 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<0.001). The re-exploration rate was higher in phase 1 (31.8%) than in phase 1 (4%) (P=0.018). The flap failure rate was higher in phase 1 (9.1%) than in phase 1 (4%), but this difference was not statistically significant (P=0.593). CONCLUSION: The learning curve of free-flap head and neck reconstruction seems to stabilize after approximately 20 cases.
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spelling pubmed-91492342022-06-01 Cumulative Sum Analysis of the Learning Curve of Free Flap Reconstruction in Head and Neck Cancer Patients Han, Seung Hoon Kim, Young Chul Kwon, Tack-Kyun Lee, Doh Young Clin Exp Otorhinolaryngol Original Article 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<0.001). The re-exploration rate was higher in phase 1 (31.8%) than in phase 1 (4%) (P=0.018). The flap failure rate was higher in phase 1 (9.1%) than in phase 1 (4%), but this difference was not statistically significant (P=0.593). CONCLUSION: The learning curve of free-flap head and neck reconstruction seems to stabilize after approximately 20 cases. Korean Society of Otorhinolaryngology-Head and Neck Surgery 2022-05 2022-03-04 /pmc/articles/PMC9149234/ /pubmed/35249319 http://dx.doi.org/10.21053/ceo.2021.01053 Text en Copyright © 2022 by Korean Society of Otorhinolaryngology-Head and Neck Surgery https://creativecommons.org/licenses/by-nc/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Han, Seung Hoon
Kim, Young Chul
Kwon, Tack-Kyun
Lee, Doh Young
Cumulative Sum Analysis of the Learning Curve of Free Flap Reconstruction in Head and Neck Cancer Patients
title Cumulative Sum Analysis of the Learning Curve of Free Flap Reconstruction in Head and Neck Cancer Patients
title_full Cumulative Sum Analysis of the Learning Curve of Free Flap Reconstruction in Head and Neck Cancer Patients
title_fullStr Cumulative Sum Analysis of the Learning Curve of Free Flap Reconstruction in Head and Neck Cancer Patients
title_full_unstemmed Cumulative Sum Analysis of the Learning Curve of Free Flap Reconstruction in Head and Neck Cancer Patients
title_short Cumulative Sum Analysis of the Learning Curve of Free Flap Reconstruction in Head and Neck Cancer Patients
title_sort cumulative sum analysis of the learning curve of free flap reconstruction in head and neck cancer patients
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9149234/
https://www.ncbi.nlm.nih.gov/pubmed/35249319
http://dx.doi.org/10.21053/ceo.2021.01053
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