Measuring surgical competency in facial trauma: the Arch Bar Placement Assessment Scale.

BACKGROUND: Surgical education is in a period of significant change. Assessment of surgical competency is imprecise compared with cognitive knowledge and judgment. A surgical competency measurement tool may be useful for plastic surgery training programs and certification societies. We present a validation study of a novel measurement instrument for arch bar placement and dental wire handling. METHODS: An Arch Bar Placement Assessment Scale (ABPAS) was created via consensus by 2 craniofacial and 2 maxillofacial surgeons. Residents and faculty members of plastic and maxillofacial surgery (n = 20) then placed an arch bar on the lower jaw of a skull model. Performances were video recorded without revealing identities. Two study groups were created based on subjects experience level: group 1 (n = 10) previously placed fewer than 25 arch bars; group 2 (n = 10) previously placed more than 25 arch bars. Two craniofacial surgeons used the ABPAS to blindly grade surgical performance. RESULTS: The ABPAS consisted of a 48-point rating scale that included a 23-point task-specific work list and a 25-point global rating scale. Pearson coefficient showed limited intraobserver (P = 0.97) and interobserver (P = 0.95) variance of test scores. The ABPAS demonstrated superior performance in group 2 in the task-specific work list [12.6 (5.5) vs 17.6 (1.5), P = 0.02], global rating scale [17.4 (4.4) vs 22 (2.1), P = 0.01], and ABPAS score [30 (9.8) and 39.6 (3.2), P = 0.01]. CONCLUSIONS: The ABPAS is a novel measurement tool which assesses technical surgical skill and can identify surgical competency in arch bar placement and dental wire handling. This tool may have future use in residency training and continuing education.

Craniosynostosis: a single institution's outcome assessment from surgical reconstruction.

PURPOSE: A retrospective review of a single institution's 20-year experience of complications and reoperation rates after surgery for primary craniosynostosis correction. METHODOLOGY: A retrospective chart review of all patients (n = 376) undergoing primary surgery for craniosynostosis was conducted. The charts were analyzed for diagnosis, sex, syndromic involvement, age at operation, type of fixation, complications, and reoperations. Complications were defined as any event requiring prolonged hospitalization or readmission secondary to the surgical procedure, reoperation, or mortality. Reoperative rates were classified into major (e.g., repeat craniotomy, cranioplasty) or minor (e.g., hardware removal, wound closure). RESULTS: After excluding patients for length of follow-up less than 6 months (n = 23), inadequate verification of all data (n = 21), and prior neurosurgical craniectomy (n = 18), a total of 314 patients were identified. The percentage of patients with complications and reoperations was 39.2% (n = 123). The rates of major reoperation (n = 72), minor reoperation (n = 41), and various complications (n = 10) were 22.9%, 13.1%, and 3.2%, respectively. No mortalities were identified. CONCLUSIONS: Differing types of fixation, diagnosis of syndrome, and multiple-suture craniosynostosis were statistically correlated to increased reoperative rates. Age at initial operation and sex were not correlated to increased reoperative rates. Finally, this institution's complication and reoperative rates compare with other published results.