Results of single-incision distal biceps tendon repair for early-career upper-extremity surgeons

Abstract

Background: The purpose of this investigation was to assess surgical outcomes after distal biceps tendon (DBT) repair for upper-extremity surgeons at the beginning of their careers, immediately following fellowship training. We aimed to determine if procedure times, complication rates, and clinical outcomes differed during the learning curve period for these early-career surgeons.

Methods: All cases of DBT repairs performed by 2 fellowship-trained surgeons from the start of their careers were included. Demographic data as well as operative times, complication rates, and patient reported outcomes were retrospectively collected. A cumulative sum chart (CUSUM) analysis was performed for the learning curve for both operative times and complication rate. This analysis continuously compares performance of an outcome to a predefined target level.

Results: A total of 78 DBT repairs performed by the two surgeons were included. In the CUSUM analysis of operative time for surgeon 1 and 2, both demonstrated a learning curve until case 4. In CUSUM analysis for complication rates, neither surgeon 1 nor surgeon 2 performed significantly worse than the target value and learning curve ranged from 14 to 21 cases. Mean Disabilities of Arm, Shoulder, and Hand score (QuickDASH) (10.65 ± 5.81) and the pain visual analog scale scores (1.13 ± 2.04) were comparable to previously reported literature.

Conclusions: These data suggest that a learning curve between 4 and 20 cases exists with respect to operative times and complication rates for DBT repairs for fellowship-trained upper-extremity surgeons at the start of clinical practice. Early-career surgeons appear to have acceptable clinical results and complications relative to previously published series irrespective of their learning stage.

Keywords: Distal biceps repair; Distal biceps rupture; Elbow surgery; Patient reported outcome measures; Surgical complications; Surgical learning curve.

Figure 1

(A) CUSUM analysis of operative time for surgeon 1 across consecutive distal biceps repairs. (B) CUSUM analysis of operative time for surgeon 2 across consecutive distal biceps. CUSUM, cumulative sum chart.

Figure 2

Distal bicep operative repair time based on cases completed for 2 surgeons.

Figure 3

(A) CUSUM analysis of complication rate for surgeon 1 across consecutive distal biceps repairs where h1 is defined as a statistically significant “unacceptable” rate of performance and h0 is defined as a statistically significant “acceptable” rate of performance. (B) CUSUM analysis of complication rate for surgeon 2 across consecutive distal biceps repairs where h1 is defined as a statistically significant “unacceptable” rate of performance and h0 is defined as a statistically significant “acceptable” rate of performance. CUMSUM, cumulative sum chart.