102 lumbar pedicle subtraction osteotomies: one surgeon’s learning curve
Purpose Pedicle Subtraction Osteotomy (PSO) is an effective surgical technique for the correction of fixed sagittal malalignment of the spine. It is a demanding technique that requires a long learning curve. The aim of this study is to analyze a surgeon’s learning curve for lumbar PSO in relation to...
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Veröffentlicht in: | European spine journal 2018-03, Vol.27 (3), p.652-660 |
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creator | Bourghli, Anouar Cawley, Derek Novoa, Felipe Rey, Manuela Alzakri, Abdulmajeed Larrieu, Daniel Vital, Jean-Marc Gille, Olivier Boissiere, Louis Obeid, Ibrahim |
description | Purpose
Pedicle Subtraction Osteotomy (PSO) is an effective surgical technique for the correction of fixed sagittal malalignment of the spine. It is a demanding technique that requires a long learning curve. The aim of this study is to analyze a surgeon’s learning curve for lumbar PSO in relation to the preoperative, perioperative, and postoperative management, with assessment of the global outcome.
Materials and methods
102 patients operated over an 8-year period were included, distributed in 3 groups over the time, and retrospectively analyzed. The following data were collected: demographic characteristics, preoperative and postoperative radiological parameters, operative technical details, and complications. Multiple regression analysis was performed, and while the number of cases was the predictor, other variables such as demographic, radiographical, and surgical variables were considered as a covariate in the final model.
Results
When comparing the first group and the last group of patients, the mean surgical time had decreased by 50 min, the estimated blood loss was decreased by 655 ml, and a significant decrease in dural tear occurrence was noticed. In addition, we found a significant decrease in the hospital stay length. Multivariate linear regression analysis showed that when the surgeon’s experience doubles, the operative time decreases by 29 min, the blood loss by 281 ml, and the odds of hospital stay ≥ 21 days decrease by 0.66 times.
Conclusion
PSO technique has a relatively long learning curve. This study showed that accumulating the experience over the years, while performing cases on a regular basis, is definitely the key in mastering this complex and risky technique, with significant improvements in the perioperative parameters that directly impact the recovery and global outcome.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material. |
doi_str_mv | 10.1007/s00586-018-5481-8 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1993013179</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1993584172</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-e70ecd4d9715ff59c27030e0443cbec60a7b0bdca54b4888164eb9f1d3f1a27f3</originalsourceid><addsrcrecordid>eNp1kM9q3DAQh0VoSDbbPkAvxdBLL05mJNmSeitLmz8EcknOQpbHixfb2kp2ILe8Rl4vTxJvNy2hkNMc5vv9ZvgY-4xwigDqLAEUuswBdV5Ijbk-YAuUgudgBP_AFmAk5KVCc8xOUtoAYGGgPGLH3AgtpFYLdoXAs27qKxezLdWt7yhLUzVG58c2DFlII4Ux9C2l71kYdsu4pjA8Pz6lrCMXh3ZYZ36K9_SRHTauS_TpdS7Z3a-ft6uL_Prm_HL14zr3QvExJwXka1kbhUXTFMZzBQIIpBS-Il-CUxVUtXeFrKTWGktJlWmwFg06rhqxZN_2vdsYfk-URtu3yVPXuYHClCwaIwAFKjOjX_9DN2GKw_zdH6rQEhWfKdxTPoaUIjV2G9vexQeLYHei7V60nUXbnWir58yX1-ap6qn-l_hrdgb4HkjzalhTfHP63dYXnqaJCw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1993584172</pqid></control><display><type>article</type><title>102 lumbar pedicle subtraction osteotomies: one surgeon’s learning curve</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Bourghli, Anouar ; Cawley, Derek ; Novoa, Felipe ; Rey, Manuela ; Alzakri, Abdulmajeed ; Larrieu, Daniel ; Vital, Jean-Marc ; Gille, Olivier ; Boissiere, Louis ; Obeid, Ibrahim</creator><creatorcontrib>Bourghli, Anouar ; Cawley, Derek ; Novoa, Felipe ; Rey, Manuela ; Alzakri, Abdulmajeed ; Larrieu, Daniel ; Vital, Jean-Marc ; Gille, Olivier ; Boissiere, Louis ; Obeid, Ibrahim</creatorcontrib><description>Purpose
Pedicle Subtraction Osteotomy (PSO) is an effective surgical technique for the correction of fixed sagittal malalignment of the spine. It is a demanding technique that requires a long learning curve. The aim of this study is to analyze a surgeon’s learning curve for lumbar PSO in relation to the preoperative, perioperative, and postoperative management, with assessment of the global outcome.
Materials and methods
102 patients operated over an 8-year period were included, distributed in 3 groups over the time, and retrospectively analyzed. The following data were collected: demographic characteristics, preoperative and postoperative radiological parameters, operative technical details, and complications. Multiple regression analysis was performed, and while the number of cases was the predictor, other variables such as demographic, radiographical, and surgical variables were considered as a covariate in the final model.
Results
When comparing the first group and the last group of patients, the mean surgical time had decreased by 50 min, the estimated blood loss was decreased by 655 ml, and a significant decrease in dural tear occurrence was noticed. In addition, we found a significant decrease in the hospital stay length. Multivariate linear regression analysis showed that when the surgeon’s experience doubles, the operative time decreases by 29 min, the blood loss by 281 ml, and the odds of hospital stay ≥ 21 days decrease by 0.66 times.
Conclusion
PSO technique has a relatively long learning curve. This study showed that accumulating the experience over the years, while performing cases on a regular basis, is definitely the key in mastering this complex and risky technique, with significant improvements in the perioperative parameters that directly impact the recovery and global outcome.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.</description><identifier>ISSN: 0940-6719</identifier><identifier>EISSN: 1432-0932</identifier><identifier>DOI: 10.1007/s00586-018-5481-8</identifier><identifier>PMID: 29383487</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Blood Loss, Surgical ; Data processing ; Female ; Humans ; Intraoperative Complications ; Learning ; Learning Curve ; Length of Stay ; Lumbar Vertebrae - surgery ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Multiple regression analysis ; Neurosurgery ; Operative Time ; Original Article ; Osteotomy ; Osteotomy - education ; Osteotomy - methods ; Regression analysis ; Retrospective Studies ; Spine (lumbar) ; Surgeons ; Surgical Orthopedics</subject><ispartof>European spine journal, 2018-03, Vol.27 (3), p.652-660</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2018</rights><rights>European Spine Journal is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-e70ecd4d9715ff59c27030e0443cbec60a7b0bdca54b4888164eb9f1d3f1a27f3</citedby><cites>FETCH-LOGICAL-c372t-e70ecd4d9715ff59c27030e0443cbec60a7b0bdca54b4888164eb9f1d3f1a27f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00586-018-5481-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00586-018-5481-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,782,786,27931,27932,41495,42564,51326</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29383487$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bourghli, Anouar</creatorcontrib><creatorcontrib>Cawley, Derek</creatorcontrib><creatorcontrib>Novoa, Felipe</creatorcontrib><creatorcontrib>Rey, Manuela</creatorcontrib><creatorcontrib>Alzakri, Abdulmajeed</creatorcontrib><creatorcontrib>Larrieu, Daniel</creatorcontrib><creatorcontrib>Vital, Jean-Marc</creatorcontrib><creatorcontrib>Gille, Olivier</creatorcontrib><creatorcontrib>Boissiere, Louis</creatorcontrib><creatorcontrib>Obeid, Ibrahim</creatorcontrib><title>102 lumbar pedicle subtraction osteotomies: one surgeon’s learning curve</title><title>European spine journal</title><addtitle>Eur Spine J</addtitle><addtitle>Eur Spine J</addtitle><description>Purpose
Pedicle Subtraction Osteotomy (PSO) is an effective surgical technique for the correction of fixed sagittal malalignment of the spine. It is a demanding technique that requires a long learning curve. The aim of this study is to analyze a surgeon’s learning curve for lumbar PSO in relation to the preoperative, perioperative, and postoperative management, with assessment of the global outcome.
Materials and methods
102 patients operated over an 8-year period were included, distributed in 3 groups over the time, and retrospectively analyzed. The following data were collected: demographic characteristics, preoperative and postoperative radiological parameters, operative technical details, and complications. Multiple regression analysis was performed, and while the number of cases was the predictor, other variables such as demographic, radiographical, and surgical variables were considered as a covariate in the final model.
Results
When comparing the first group and the last group of patients, the mean surgical time had decreased by 50 min, the estimated blood loss was decreased by 655 ml, and a significant decrease in dural tear occurrence was noticed. In addition, we found a significant decrease in the hospital stay length. Multivariate linear regression analysis showed that when the surgeon’s experience doubles, the operative time decreases by 29 min, the blood loss by 281 ml, and the odds of hospital stay ≥ 21 days decrease by 0.66 times.
Conclusion
PSO technique has a relatively long learning curve. This study showed that accumulating the experience over the years, while performing cases on a regular basis, is definitely the key in mastering this complex and risky technique, with significant improvements in the perioperative parameters that directly impact the recovery and global outcome.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.</description><subject>Blood Loss, Surgical</subject><subject>Data processing</subject><subject>Female</subject><subject>Humans</subject><subject>Intraoperative Complications</subject><subject>Learning</subject><subject>Learning Curve</subject><subject>Length of Stay</subject><subject>Lumbar Vertebrae - surgery</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Multiple regression analysis</subject><subject>Neurosurgery</subject><subject>Operative Time</subject><subject>Original Article</subject><subject>Osteotomy</subject><subject>Osteotomy - education</subject><subject>Osteotomy - methods</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Spine (lumbar)</subject><subject>Surgeons</subject><subject>Surgical Orthopedics</subject><issn>0940-6719</issn><issn>1432-0932</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kM9q3DAQh0VoSDbbPkAvxdBLL05mJNmSeitLmz8EcknOQpbHixfb2kp2ILe8Rl4vTxJvNy2hkNMc5vv9ZvgY-4xwigDqLAEUuswBdV5Ijbk-YAuUgudgBP_AFmAk5KVCc8xOUtoAYGGgPGLH3AgtpFYLdoXAs27qKxezLdWt7yhLUzVG58c2DFlII4Ux9C2l71kYdsu4pjA8Pz6lrCMXh3ZYZ36K9_SRHTauS_TpdS7Z3a-ft6uL_Prm_HL14zr3QvExJwXka1kbhUXTFMZzBQIIpBS-Il-CUxVUtXeFrKTWGktJlWmwFg06rhqxZN_2vdsYfk-URtu3yVPXuYHClCwaIwAFKjOjX_9DN2GKw_zdH6rQEhWfKdxTPoaUIjV2G9vexQeLYHei7V60nUXbnWir58yX1-ap6qn-l_hrdgb4HkjzalhTfHP63dYXnqaJCw</recordid><startdate>20180301</startdate><enddate>20180301</enddate><creator>Bourghli, Anouar</creator><creator>Cawley, Derek</creator><creator>Novoa, Felipe</creator><creator>Rey, Manuela</creator><creator>Alzakri, Abdulmajeed</creator><creator>Larrieu, Daniel</creator><creator>Vital, Jean-Marc</creator><creator>Gille, Olivier</creator><creator>Boissiere, Louis</creator><creator>Obeid, Ibrahim</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20180301</creationdate><title>102 lumbar pedicle subtraction osteotomies: one surgeon’s learning curve</title><author>Bourghli, Anouar ; Cawley, Derek ; Novoa, Felipe ; Rey, Manuela ; Alzakri, Abdulmajeed ; Larrieu, Daniel ; Vital, Jean-Marc ; Gille, Olivier ; Boissiere, Louis ; Obeid, Ibrahim</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-e70ecd4d9715ff59c27030e0443cbec60a7b0bdca54b4888164eb9f1d3f1a27f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Blood Loss, Surgical</topic><topic>Data processing</topic><topic>Female</topic><topic>Humans</topic><topic>Intraoperative Complications</topic><topic>Learning</topic><topic>Learning Curve</topic><topic>Length of Stay</topic><topic>Lumbar Vertebrae - surgery</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Multiple regression analysis</topic><topic>Neurosurgery</topic><topic>Operative Time</topic><topic>Original Article</topic><topic>Osteotomy</topic><topic>Osteotomy - education</topic><topic>Osteotomy - methods</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Spine (lumbar)</topic><topic>Surgeons</topic><topic>Surgical Orthopedics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bourghli, Anouar</creatorcontrib><creatorcontrib>Cawley, Derek</creatorcontrib><creatorcontrib>Novoa, Felipe</creatorcontrib><creatorcontrib>Rey, Manuela</creatorcontrib><creatorcontrib>Alzakri, Abdulmajeed</creatorcontrib><creatorcontrib>Larrieu, Daniel</creatorcontrib><creatorcontrib>Vital, Jean-Marc</creatorcontrib><creatorcontrib>Gille, Olivier</creatorcontrib><creatorcontrib>Boissiere, Louis</creatorcontrib><creatorcontrib>Obeid, Ibrahim</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>European spine journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bourghli, Anouar</au><au>Cawley, Derek</au><au>Novoa, Felipe</au><au>Rey, Manuela</au><au>Alzakri, Abdulmajeed</au><au>Larrieu, Daniel</au><au>Vital, Jean-Marc</au><au>Gille, Olivier</au><au>Boissiere, Louis</au><au>Obeid, Ibrahim</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>102 lumbar pedicle subtraction osteotomies: one surgeon’s learning curve</atitle><jtitle>European spine journal</jtitle><stitle>Eur Spine J</stitle><addtitle>Eur Spine J</addtitle><date>2018-03-01</date><risdate>2018</risdate><volume>27</volume><issue>3</issue><spage>652</spage><epage>660</epage><pages>652-660</pages><issn>0940-6719</issn><eissn>1432-0932</eissn><abstract>Purpose
Pedicle Subtraction Osteotomy (PSO) is an effective surgical technique for the correction of fixed sagittal malalignment of the spine. It is a demanding technique that requires a long learning curve. The aim of this study is to analyze a surgeon’s learning curve for lumbar PSO in relation to the preoperative, perioperative, and postoperative management, with assessment of the global outcome.
Materials and methods
102 patients operated over an 8-year period were included, distributed in 3 groups over the time, and retrospectively analyzed. The following data were collected: demographic characteristics, preoperative and postoperative radiological parameters, operative technical details, and complications. Multiple regression analysis was performed, and while the number of cases was the predictor, other variables such as demographic, radiographical, and surgical variables were considered as a covariate in the final model.
Results
When comparing the first group and the last group of patients, the mean surgical time had decreased by 50 min, the estimated blood loss was decreased by 655 ml, and a significant decrease in dural tear occurrence was noticed. In addition, we found a significant decrease in the hospital stay length. Multivariate linear regression analysis showed that when the surgeon’s experience doubles, the operative time decreases by 29 min, the blood loss by 281 ml, and the odds of hospital stay ≥ 21 days decrease by 0.66 times.
Conclusion
PSO technique has a relatively long learning curve. This study showed that accumulating the experience over the years, while performing cases on a regular basis, is definitely the key in mastering this complex and risky technique, with significant improvements in the perioperative parameters that directly impact the recovery and global outcome.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>29383487</pmid><doi>10.1007/s00586-018-5481-8</doi><tpages>9</tpages></addata></record> |
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subjects | Blood Loss, Surgical Data processing Female Humans Intraoperative Complications Learning Learning Curve Length of Stay Lumbar Vertebrae - surgery Male Medicine Medicine & Public Health Middle Aged Multiple regression analysis Neurosurgery Operative Time Original Article Osteotomy Osteotomy - education Osteotomy - methods Regression analysis Retrospective Studies Spine (lumbar) Surgeons Surgical Orthopedics |
title | 102 lumbar pedicle subtraction osteotomies: one surgeon’s learning curve |
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