精准医学杂志 (Oct 2024)
Determination and significance of the learning curve threshold for robot-assisted mitral valve replacement
Abstract
Objective To investigate the learning curve threshold for robot-assisted mitral valve replacement, and to provide guidance for clinical practice. Methods A retrospective analysis was performed for the clinical data of 37 patients who underwent robot-assisted mitral valve replacement in Department of Cardiovascular Surgery in our hospital from December 2014 to December 2017, and the patients were ordered based on date of surgery. The cumulative sum (CUSUM) was calculated for time of operation, duration of cardiopulmonary bypass (CPB), and aortic cross-clamp time, and the CUSUM learning curve was modeled by curve fitting. The patients were divided into two groups based on the highest CUSUM of time of operation, and the two groups were compared in terms of general information, time of operation, duration of CPB, aortic cross-clamp time, total drainage volume (the sum of retrosternal drainage volume and thoracic drainage volume) during the 3 days before surgery, length of hospital stay, use of drugs and blood products in the perioperative period, and whether secondary thoracotomy was performed. Results The fitting curve reached the top at the 9th case on the time of operation, and the highest numbers of CPB and aortic cross-clamp time were 12 and 11, respectively. The patients were divided into two groups at the 9th case, and there were significant differences between the two groups in total drainage volume and the amount of red blood cell and plasma used after surgery on days 2 and 3 (Z=2.21-2.55,P<0.05). Conclusion The minimum number of cases is 9 for robot-assisted mitral valve replacement to develop from the learning stage to the proficiency stage. Changes in patient conditions should be closely monitored during the learning stage to actively improve their prognosis.
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