Scholarlink

Background <p>Transanal hemorrhoidal dearterialization (THD) with Anolift mucopexy is a validated non-excisional procedure for hemorrhoidal disease. Although surgeon experience is acknowledged as a determinant of THD outcomes, no formal learning curve analysis exists. This study aimed to characterize the learning curve of a single surgeon adopting THD-Anolift.</p> Methods <p>Retrospective analysis of 60 consecutive THD-Anolift cases (May 2023–February 2026). Nine patients with incomplete outcome data were excluded, leaving 51 for analysis. Median follow-up was 12&#xa0;months (range 3–33). Cumulative sum (CUSUM) charts were constructed for a composite failure endpoint (recurrence and/or any complication) and for operative time. The proficiency point was identified at the CUSUM inflection. Sensitivity analyses included CUSUM on recurrence alone, CUSUM restricted to recurrence and Clavien-Dindo ≥ II complications, best-case/worst-case imputation for excluded patients, and risk-adjusted CUSUM controlling for hemorrhoid grade and previous procedures.</p> Results <p>Median age was 53&#xa0;years; 72.5% were male; 80.4% had grade III hemorrhoids. The overall composite failure rate was 37.3% (19/51) and the recurrence rate 15.7% (8/51). Mean operative time was 23.5 ± 7.4&#xa0;min. The composite outcome CUSUM identified a proficiency point at case 23: the failure rate decreased from 52.2% in Phase 1 (cases 1–23) to 25.0% in Phase 2 (cases 24–51; <i>p</i> = 0.080, not statistically significant at the conventional threshold). Operative time decreased from 27.1 ± 7.4 to 20.4 ± 6.0&#xa0;min (<i>p</i> &lt; 0.001). On sensitivity analysis, both the recurrence-only CUSUM and the risk-adjusted CUSUM confirmed an identical proficiency point at case 23, and worst-case/best-case imputation for excluded patients moved the inflection only to cases 25 and 22 respectively, indicating that the finding was robust to endpoint definition and case-mix variation, as well as to plausible patterns of missing data.</p> Conclusions <p>CUSUM analysis identified an inflection at approximately 23 cases, with a statistically significant reduction in operative time and a clinically relevant but underpowered reduction in composite failure that did not reach the conventional threshold for statistical significance. Rather than a fixed competency threshold, these findings provide an initial benchmark to help structure supervised adoption—suggesting that the 10 mentored cases conventionally proposed in industry-sponsored teaching may be insufficient— and to inform future multicenter validation.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Defining proficiency in THD-Anolift: a CUSUM analysis of the learning curve in 51 consecutive cases

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年5月20日

查看全文
  • Andrea Cesare Galli,
  • Gianlorenzo Dionigi,
  • Sara Lauricella,
  • Sergio Agradi,
  • Richard Sassun,
  • Angelo Emanuele Leone,
  • Roberto Cirocchi,
  • Francesco Brucchi

摘要

Background

Transanal hemorrhoidal dearterialization (THD) with Anolift mucopexy is a validated non-excisional procedure for hemorrhoidal disease. Although surgeon experience is acknowledged as a determinant of THD outcomes, no formal learning curve analysis exists. This study aimed to characterize the learning curve of a single surgeon adopting THD-Anolift.

Methods

Retrospective analysis of 60 consecutive THD-Anolift cases (May 2023–February 2026). Nine patients with incomplete outcome data were excluded, leaving 51 for analysis. Median follow-up was 12 months (range 3–33). Cumulative sum (CUSUM) charts were constructed for a composite failure endpoint (recurrence and/or any complication) and for operative time. The proficiency point was identified at the CUSUM inflection. Sensitivity analyses included CUSUM on recurrence alone, CUSUM restricted to recurrence and Clavien-Dindo ≥ II complications, best-case/worst-case imputation for excluded patients, and risk-adjusted CUSUM controlling for hemorrhoid grade and previous procedures.

Results

Median age was 53 years; 72.5% were male; 80.4% had grade III hemorrhoids. The overall composite failure rate was 37.3% (19/51) and the recurrence rate 15.7% (8/51). Mean operative time was 23.5 ± 7.4 min. The composite outcome CUSUM identified a proficiency point at case 23: the failure rate decreased from 52.2% in Phase 1 (cases 1–23) to 25.0% in Phase 2 (cases 24–51; p = 0.080, not statistically significant at the conventional threshold). Operative time decreased from 27.1 ± 7.4 to 20.4 ± 6.0 min (p < 0.001). On sensitivity analysis, both the recurrence-only CUSUM and the risk-adjusted CUSUM confirmed an identical proficiency point at case 23, and worst-case/best-case imputation for excluded patients moved the inflection only to cases 25 and 22 respectively, indicating that the finding was robust to endpoint definition and case-mix variation, as well as to plausible patterns of missing data.

Conclusions

CUSUM analysis identified an inflection at approximately 23 cases, with a statistically significant reduction in operative time and a clinically relevant but underpowered reduction in composite failure that did not reach the conventional threshold for statistical significance. Rather than a fixed competency threshold, these findings provide an initial benchmark to help structure supervised adoption—suggesting that the 10 mentored cases conventionally proposed in industry-sponsored teaching may be insufficient— and to inform future multicenter validation.