Learning Curve Analysis of Pelvic Organ Prolapse Surgery Among Urogynecology and Aesthetic Reconstruction Trainees

Abstract

Background: Pelvic organ prolapse (POP) is a condition in which pelvic organs descend into the vaginal canal due to weakened muscles and tissues. It represents a significant global health burden with a worldwide prevalence of 30.9% and 26.4% in Jakarta. As the female life expectancy in Indonesia continues to rise, the prevalence of POP estimated to increase by 40%, further affecting women’s quality of life. The need for POP surgery is projected to reach 48.1% by 2050. Given the complexity of POP reconstruction, adequate training and evaluation of urogynecology subspecialists are essential to ensure patient safety and optimal outcomes.

Objective: To analyze the learning curve of POP surgeries performed by urogynecology subspecialty trainees at RSCM using the Cumulative Sum (CUSUM) method in order to evaluate surgical skill development and optimize clinical training quality.

Methods: This study applied a CUSUM learning curve analysis to assess the performance of three subspecialty trainees during ten POP reconstructive surgeries. Variables analyzed included operation duration and intraoperative blood loss.

Result: CUSUM analysis is able to identify the point at which trainees achieve procedural competence and stable performance, reflected by plateau phase in operation time and reduced intraoperative bleeding. This method allows for early detection of learning challenges and facilitates timely corrective actions during training.

Conclusions: CUSUM learning curve analysis provides a sensitive and continuous assessment tool for monitoring surgical competency of urogynecology subspecialty trainees. This approach in clinical training can enhance the standardization of education, improve patient safety, and optimize clinical outcomes in POP management.