title: Use of the cumulative summation technique to quantitatively assess a surgical learning curve: canine total hip replacement.
abstract: OBJECTIVE
  To quantitatively assess a surgical "learning curve" using the cumulative summation (CUSUM) score technique.
  
  
  METHODS
  Application of a CUSUM technique to a consecutive series of surgical cases.
  
  
  METHODS
  Consecutive primary cemented total hip replacement (THR; n=116) in 106 dogs.
  
  
  METHODS
  Records of all dogs that had primary canine THR were reviewed. Data retrieved included date of surgery, postoperative complications, and duration of follow-up. The 12-week outcome was analyzed graphically and with a CUSUM technique.
  
  
  RESULTS
  One hundred and one (87%) procedures were "successful" and 15 (13%) developed major complications within 12 weeks (failures). The CUSUM chart clearly demonstrated an initial "learning curve" of ∼44 THR.
  
  
  CONCLUSIONS
  The CUSUM technique can be used to demonstrate the learning curve for canine THR surgery.
authors.affiliation: Department of Veterinary Medicine, University of Cambridge, Cambridge, UK. gh327@cam.ac.uk
authors.forename: Graham M
authors.initials: GM
authors.lastname: Hayes
authors.forename: Juan
authors.initials: J
authors.lastname: Ramirez
authors.forename: Sorrel J
authors.initials: SJ
authors.lastname: Langley Hobbs
mesh_terms: D000818:Animals; D019644:Arthroplasty, Replacement, Hip / Q000193:education / Q000662:veterinary*; D004283:Dog Diseases / Q000601:surgery*; D004285:Dogs; D004520:Education, Veterinary / Q000592:standards*; D006614:Hindlimb / Q000473:pathology; D007592:Joint Diseases / Q000601:surgery / Q000662:veterinary; D011183:Postoperative Complications / Q000662:veterinary; D012189:Retrospective Studies; D018634:Veterinarians / Q000592:standards*