Learning Curve for Strabismus Surgery

ABSTRACT

PURPOSE: In the present study, we evaluated the learning curve of strabismus surgery performed by a single surgeon. METHODS: We reviewed the data of 62 patients with exodeviation who underwent strabismus surgery and were followed up for at least 3 months between March 2011 and November 2014. Patients were divided into 3 groups classified chronologically and the success rate in each group was investigated. Additionally, the results of exotropia surgery were analyzed using cumulative sum (CUSUM) analysis. We compared 5 m distal angle deviation preoperatively and 3 months after strabismus surgery. RESULTS: The overall surgical success rate of 62 patients was 72.6% (45/62). Success rates were 70% (14/20) in the first group, 71.4% (15/21) in the second group and 76.2% (16/21) in the third group. CUSUM analysis indicated that a surgeon's performance begins to improve at attempt number 11 and cumulative failure chart suggested the surgeon had achieved acceptable level of performance after 44 surgeries. CONCLUSIONS: A novice strabismus surgeon showed performance improvement after 11 cases and achieved acceptable level of performance after 44 strabismus surgeries. Although additional statistical data using more cases is needed, we suggest surgeons should perform at least 50 strabismus surgeries to ensure a high success rate.