Analysis of the vitreoretinal surgery learning curve.
OBJECTIVE
To describe intra- and post-operative complications, as well as the evolution of the surgical technique in first 4years of work of a novice retina surgeon, and evaluate minimal learning time required to reduce its complications, deciding which pathologies should still be referred to higher level hospitals, until further experience may be achieved.


METHODS
A study was conducted on patients that had undergone vitreoretinal surgery by a novice surgeon in Tarragona between 23rd October 2007 and 31st December 2011. The primary diagnosis, surgeon learning time, surgical technique, intra-operative and post-operative complications were recorded.


RESULTS
A total of 247 surgeries were studied. The percentage of use of 20G and 23G calibres during the time, marks a change towards trans-conjunctival surgery from the ninth trimester (98 surgeries). Surgical complications decreased towards twelfth trimester (130 surgeries) with an increase in the previous months.


CONCLUSIONS
The shift towards 23G technique around 100 surgeries is interpreted as greater comfort and safety by the surgeon. Increased surgical complications during the following months until its decline around 130 surgeries can be interpreted as an 'overconfidence'. It is arguable that the learning curve is slower than what the surgeon believes. An individual analysis of the complications and surgical outcomes is recommended to ascertain the status of the learning curve.
Servicio de Oftalmología, Xarxa Sanitària i Social de Santa Tecla, Tarragona, España. Electronic address: drjmartin@drjmartin.com.
J
J
Martín-Avià
Servicio de Oftalmología, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili [IISPV], Universitat Rovira i Virgili, Reus, Tarragona, España.
P
P
Romero-Aroca
D001291:Attitude of Health Personnel; D005257:Fellowships and Scholarships; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D059032:Learning Curve; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012163:Retinal Detachment / Q000601:surgery; D012189:Retrospective Studies; D013030:Spain; D066231:Surgeons / Q000523:psychology; D013537:Sutures; D014821:Vitrectomy / Q000379:methods / Q000706:statistics & numerical data; D057586:Vitreoretinal Surgery / Q000379:methods / Q000706:statistics & numerical data; D014823:Vitreous Hemorrhage / Q000601:surgery
Cirugía vitreorretiniana; Curva de aprendizaje; Desprendimiento de retina; Epiretinal membrane; Habilidades quirúrgicas; Hemorragia vítrea; Learning curve; Membrana epirretiniana; Retinal detachment; Surgical skills; Vitrectomy; Vitrectomía; Vitreoretinal surgery; Vitreous haemorrhage