Use of the cumulative summation technique to quantitatively assess a surgical learning curve: canine total hip replacement.

Abstract

OBJECTIVE: To quantitatively assess a surgical "learning curve" using the cumulative summation (CUSUM) score technique. STUDY DESIGN: Application of a CUSUM technique to a consecutive series of surgical cases. ANIMALS: Consecutive primary cemented total hip replacement (THR; n=116) in 106 dogs. METHODS: Records of all dogs that had primary canine THR were reviewed. Data retrieved included date of surgery, postoperative complications, and duration of follow-up. The 12-week outcome was analyzed graphically and with a CUSUM technique. RESULTS: One hundred and one (87%) procedures were "successful" and 15 (13%) developed major complications within 12 weeks (failures). The CUSUM chart clearly demonstrated an initial "learning curve" of ∼44 THR. CONCLUSION: The CUSUM technique can be used to demonstrate the learning curve for canine THR surgery.