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Characterizing the Surgeon Learning Curve in Instrumented Minimally Invasive Spinal Surgery: Does the Evidence Account for Training and Experience? A Systematic Literature Review.

Abstract：

STUDY DESIGN:This was a systematic literature review. OBJECTIVE:The purpose of this systematic literature review was to aggregate all evidence characterizing the learning curve of instrumented minimally invasive surgery (MIS) techniques in spinal surgery and summarize what, if any, consideration has been given to surgeon training and experience. SUMMARY OF BACKGROUND DATA:MIS techniques have become prevalent in spine surgery given the ability to diminish the intraoperative footprint, translating to quicker patient recovery, and improved long-term outcomes. However, technical demand on the surgeon can be significant, particularly during the procedural adoption (learning curve) phase. Many studies have sought to quantify the duration and severity of these learning curve phases, with the intent to characterize MIS procedural appropriateness and safety. However, while these studies are robust regarding outcome metrics, it is not well understood whether they adequately characterize surgeon training and experience. METHODS:A systematic literature review was performed in the PubMed and MEDLINE databases in accordance with the PRISMA guidelines. All inclusion articles were screened for statements regarding surgeon experience/training. Statements were further classified by the types of metrics/variables utilized to establish a contextual history of experience/training. Descriptive statistics were reported. RESULTS:Initial search criteria yielded 458 articles, 12 met final inclusion. Seven articles (58.3%) attempted a summary statement of experience which acknowledged at least one of the following metrics: total years in practice (41.7%), years/number of cases performed using the traditional/gold-standard technique (16.7%), specification of residency/fellowship training (16.7%), use/nonuse of cadaveric or course/lab training (16.7%), and/or design of operating team (8.3%). No articles considered experience as a quantitative variable in their study analyses. CONCLUSIONS:Spine MIS learning curve studies for instrumented fusion procedures provide inadequate context/characterization of surgeon experience and training. Future efforts leveraging learning curve methodology utilized in other surgical specialties would be beneficial.

journal_name

Clin Spine Surg

journal_title

Clinical spine surgery

authors

Ferry C

doi

10.1097/BSD.0000000000001052

subject

Has Abstract

pub_date

2021-02-01 00:00:00

pages

17-21

issue

eissn

2380-0186

issn

2380-0194

pii

01933606-202102000-00004

journal_volume

pub_type

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Characterizing the Surgeon Learning Curve in Instrumented Minimally Invasive Spinal Surgery: Does the Evidence Account for Training and Experience? A Systematic Literature Review.