Peer-reviewed veterinary case report
Clinical audit for the tibial tuberosity advancement procedure: establishing the learning curve and monitoring ongoing performance for the tibial tuberosity advancement procedure using the cumulative summation technique.
- Journal:
- Veterinary and comparative orthopaedics and traumatology : V.C.O.T
- Year:
- 2013
- Authors:
- Proot, J L J & Corr, S A
- Affiliation:
- Calder Vets Ltd · United Kingdom
- Species:
- dog
Plain-English summary
This study looked at how a single surgeon improved their skills while performing a specific knee surgery called tibial tuberosity advancement (TTA) on dogs with a torn cruciate ligament. The researchers reviewed records from 122 dogs that had this surgery and found that 15 of them experienced major complications within a year, which is about 9%. As the surgeon gained more experience, the rate of complications decreased, and they reached a steady level of performance after completing 22 surgeries. Overall, the study showed that the surgeon's skills improved over time, and their complication rates remained acceptable after the learning phase.
Abstract
OBJECTIVES: To quantitatively assess the learning curve for the tibial tuberosity advancement (TTA) procedure performed by a single surgeon using the cumulative summation (CUSUM) technique and to determine if surgeon performance remained under control (i.e. within specified quality boundaries) after the learning curve had been climbed. STUDY DESIGN: Retrospective study. ANIMALS: Dogs (n = 122) with cranial cruciate ligament deficient stifles (n = 167). METHODS: Records of all dogs that had a TTA procedure performed by the same surgeon were reviewed. Cases were included if the following information was available: weight, breed, date of surgery, presence of partial or full cruciate rupture, meniscal pathology, occurrence and description of postoperative complications and treatment with a minimum of 12 months follow-up. Patients were excluded if they had a concurrent illness. Major complications were defined as those requiring revision surgery. The CUSUM technique was used to determine the time taken for the surgeon to reach a pre-defined level of competency and to monitor ongoing performance. RESULTS: Major complications occurred in 15 out of 167 procedures (9%) within 12 months of TTA surgery. The complication rate decreased as surgical experience was gained with the technique, however the learning curve continued until the 22nd procedure. Thereafter, despite the target complication rate being re-set at a lower level, the surgeon's performance remained acceptable, i.e. within the revised quality boundary. CLINICAL SIGNIFICANCE: The CUSUM technique was used for clinical audit, to determine the learning curve for the TTA procedure for a single surgeon, and to monitor ongoing performance. An experienced general practitioner had a learning curve of 22 procedures and complication rates were within the published ranges.
Find similar cases for your pet
PetCaseFinder finds other peer-reviewed reports of pets with the same symptoms, plus a plain-English summary of what was tried across them.
Search related cases →Original publication: https://pubmed.ncbi.nlm.nih.gov/23857572/