Clinical Outcomes and Learning Curve in Stapes Surgery - Experience from the First Thirty Procedures at Two Tertiary Care Hospitals

Résumé

Background: Mastering the surgery of the stapes has been widely reported as technically demanding with an exceedingly familiar learning curve that affects surgical outcomes. Understanding this learning curve is critical in optimizing training programs and optimizing patient care in progressive surgical facilities. Methods & Materials: A prospective observational analysis was conducted on the first 30 stapes surgeries performed at JRRMCH and Oasis Hospital, Sylhet by one surgical team. Operating time, intra- and postoperative complication rates, audiometric findings (closure of air-bone gap), and hospital stay were data collected. The group was divided into three groups of 10 cases to determine learning with time. Results: The analysis revealed a statistical improvement across all parameters. Operative time decreased from an average of 124 minutes for the initial 10 cases to 85 minutes for the final 10. Rates of complications decreased from 20% to 3.3%, and audiometric outcomes also improved significantly, with mean postoperative air-bone gap closure to within 10 dB in the final cohort. Hospital stay also decreased proportionally. Performance indicators were similar to those reported by experienced surgeons by the final 10 cases. Conclusion: The study demonstrates a quantifiable learning curve in stapes surgery with significant improvement in surgical efficiency, safety, and hearing outcomes within 30 cases. Such findings can justify the inclusion of formal mentorship in initial training and can guide resource planning for establishing otologic programs in the developing world. Multicenter studies are recommended in an attempt to establish the generalizability of such findings.