title: Quantitative analysis of a spinal surgeon's learning curve for scoliosis surgery.
abstract: OBJECTIVE
  The aim of this study was a quantitative analysis of a surgeon's learning curve for scoliosis surgery and the relationship between the surgeon's experience and post-operative outcomes, which has not been previously well described.
  
  
  METHODS
  We have investigated the operating time as a function of the number of patients to determine a specific pattern; we analysed factors affecting the operating time and compared intra- and post-operative outcomes. We analysed 47 consecutive patients undergoing scoliosis surgery performed by a single, non-trained scoliosis surgeon. Operating time was recorded for each of the four parts of the procedures: dissection, placement of pedicle screws, reduction of the deformity and wound closure.
  
  
  RESULTS
  The median operating time was 310 minutes (interquartile range 277.5 to 432.5). The pattern showed a continuous decreasing trend in operating time until the patient number reached 23 to 25, after which it stabilised with fewer patient-dependent changes. The operating time was more affected by the patient number (r =- 0.75) than the number of levels fused (r = 0.59). Blood loss (p = 0.016) and length of stay in hospital (p = 0.012) were significantly less after the operating time stabilised. Post-operative functional outcome scores and the rate of complications showed no significant differences.
  
  
  CONCLUSIONS
  We describe a detailed learning curve for scoliosis surgery based on a single surgeon's practise, providing useful information for novice scoliosis surgeons and for those responsible for training in spinal surgery. Cite this article: Bone Joint J 2016;98-B:679-85.
authors.affiliation: Severance Children's Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea.
authors.forename: K J
authors.initials: KJ
authors.lastname: Ryu
authors.affiliation: Korea University Guro Hospital, Seoul 152-703, Korea.
authors.forename: S W
authors.initials: SW
authors.lastname: Suh
authors.affiliation: Severance Children's Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea.
authors.forename: H W
authors.initials: HW
authors.lastname: Kim
authors.affiliation: Severance Children's Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea.
authors.forename: D H
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Severance Children's Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea.
authors.forename: Y
authors.initials: Y
authors.lastname: Yoon
authors.affiliation: Severance Children's Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Hwang
mesh_terms: D000293:Adolescent; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D065289:Pedicle Screws; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000193:education*
keywords: scoliosis; learning curve; operating time; adolescent idiopathic scoliosis; neuromuscular scoliosis