背景:内镜手术在治疗自发性脑出血(sICH)方面显示出希望,但是由于所需的高水平外科专业知识,它在县级医院的采用受到了阻碍。
方法:在县医院的这项回顾性研究中,我们利用累积和(CUSUM)控制图可视化了两名神经外科医师的学习曲线.我们比较了患者在学习和熟练阶段的结果,并将它们与基于ICH评分和ICH功能结果评分的预期结果进行比较,分别。
结果:学习曲线在NS1的第12例和NS2的第8例达到峰值,表明已过渡到熟练阶段。此阶段减少了操作时间,失血,疏散率<90%,再出血率,重症监护室逗留,住院,以及两位神经外科医生的总体费用。在学习阶段,30天内有6人死亡,低于ICH分数预测的10.66。在熟练阶段,3人死亡,低于预测的15.88。在中危和高危患者中,ICH功能结局评分,熟练阶段在三个月时mRS≥3的患者少于学习阶段(23.8%vs.69.2%,P=0.024;40%vs.80%,P=0.360)。内部通道中的微操纵双极精密止血和抽吸装置加快了从学习到熟练的过渡。
结论:数据显示了学习曲线,随着外科医生熟练程度的提高,手术效果会更好。这表明外科熟练程度的成本效益以及需要在县医院进行持续的外科教育和培训。
BACKGROUND: Endoscopic surgery has shown promise in treating Spontaneous Intracerebral Hemorrhage (sICH), but its adoption in county-level hospitals has been hindered by the high level of surgical expertise required.
METHODS: In this retrospective study at a county hospital, we utilized a Cumulative Sum (CUSUM) control chart to visualize the learning curve for two
neurosurgeons. We compared patient outcomes in the learning and proficient phases, and compared them with expected outcomes based on ICH score and ICH functional outcome score, respectively.
RESULTS: The learning curve peaked at the 12th case for NS1 and the 8th case for NS2, signifying the transition to the proficient stage. This stage saw reductions in operation time, blood loss, rates of evacuation < 90 %, rebleeding rates, intensive care unit stay, hospital stay, and overall costs for both
neurosurgeons. In the learning stage, 6 deaths occurred within 30 days, less than the 10.66 predicted by the ICH score. In the proficient stage, 3 deaths occurred, less than the 15.88 predicted. In intermediate and high-risk patients by the ICH functional outcome score, the proficient stage had fewer patients with an mRS ≥ 3 at three months than the learning stage (23.8 % vs. 69.2 %, P = 0.024; 40 % vs. 80 %, P = 0.360). Micromanipulating bipolar precision hemostasis and aspiration devices in the endoport\'s channels sped up the transition from learning to proficient.
CONCLUSIONS: The data shows a learning curve, with better surgical outcomes as surgeons gain proficiency. This suggests cost benefits of surgical proficiency and the need for ongoing surgical education and training in county hospitals.