HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Eugene H. Blackstone Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Blackstone, E. H. Search for Related Content PubMed PubMed Citation Articles by Blackstone, E. H. Related Collections Education Coronary disease Professional affairs

J Thorac Cardiovasc Surg 2004;128:807-810
© 2004 The American Association for Thoracic Surgery

Statistics for the Rest of Us

Monitoring surgical performance

^a Section of Clinical Research, Department of Thoracic and Cardiovascular Surgery and Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Received for publication February 24, 2004; accepted for publication March 5, 2004.

^* Address for reprints: Eugene H. Blackstone, MD, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F24, Cleveland, OH 44195, USA
blackse@ccf.org

The first 300 words of the full text of this article appear below.

See related articles on pages 811, 820, 823, and 907.

 

If surgical performance—often measured by postoperative outcome of initial hospital stay—is monitored at all, the most common means is by risk-adjusted annual or semiannual audit. Observed occurrence of outcome measures (eg, in-hospital death and complications) as a proportion of cases performed is compared with expected performance using, for example, the Society of Thoracic Surgeons' regression equations¹ or EuroSCORE,² which account for many aspects of case mix. Sometimes observed (O) and expected (E) proportions are subtracted, sometimes divided (O/E ratio)³; sometimes confidence limits of these comparisons are provided, and occasionally P values are given.

Is this periodic, widespread, but rather coarse monitoring of surgical performance sufficient?

	CUSUMs—what are they and why should we care?

 
During the past year, several manuscripts have been submitted to this Journal and to The Annals of Thoracic Surgery that argue for monitoring on an individual case-after-case fashion (sequential monitoring) using the ever-expanding suite of statistical quality control techniques.⁴ The most commonly used belong to the family of cumulative sum (CUSUM) charts.⁵ These charts purport to provide early identification of deviation from a performance standard. Their forte is identifying subtle, slow, but sustained degradation in a system thought to be in control.⁴ Because early, reliable warning should be good for both patients and surgeons, the editors decided that a "Statistics for the Rest of Us" tutorial on CUSUMs would be valuable for readers.

No sooner had this decision been made than (1) Gary Grunkemeier's tutorial on CUSUMs appeared in The Annals,⁶ and (2) we received a tutorial by Rogers and colleagues⁷ from Bristol. We determined that the latter would become the centerpiece of an educational package on monitoring surgical performance, along with invited commentaries from Tom Treasure and his group from Guy's Hospital and the Clinical Operational Research Unit, . . . [Full Text of this Article]

This article has been cited by other articles:

				S. C. Stoica, D. Kalavrouziotis, B.-J. Martin, K. J. Buth, G. M. Hirsch, J. A. Sullivan, and R. J.F. Baskett Long-Term Results of Heart Operations Performed by Surgeons-in-Training Circulation, September 30, 2008; 118(14_suppl_1): S1 - S6. [Abstract] [Full Text] [PDF]

				B Bridgewater and B Keogh Surgical "league tables": Ischaemic heart disease Heart, July 1, 2008; 94(7): 936 - 942. [Full Text] [PDF]

				D. M. Holzhey, S. Jacobs, T. Walther, M. Mochalski, F. W. Mohr, and V. Falk Cumulative sum failure analysis for eight surgeons performing minimally invasive direct coronary artery bypass J. Thorac. Cardiovasc. Surg., September 1, 2007; 134(3): 663 - 669. [Abstract] [Full Text] [PDF]

				L. A. Larrazabal, P. J. del Nido, K. J. Jenkins, K. Gauvreau, R. Lacro, S. D. Colan, F. Pigula, O. J. Benavidez, F. Fynn-Thompson, J. E. Mayer Jr, et al. Measurement of Technical Performance in Congenital Heart Surgery: A Pilot Study Ann. Thorac. Surg., January 1, 2007; 83(1): 179 - 184. [Abstract] [Full Text] [PDF]

				R. J. Novick, S. A. Fox, L. W. Stitt, T. L. Forbes, and S. Steiner Direct comparison of risk-adjusted and non-risk-adjusted CUSUM analyses of coronary artery bypass surgery outcomes. J. Thorac. Cardiovasc. Surg., August 1, 2006; 132(2): 386 - 391. [Abstract] [Full Text] [PDF]

				F. Lacour-Gayet Editorial comment: The goal is performance evaluation not outcome prediction Eur. J. Cardiothorac. Surg., June 1, 2006; 29(6): 989 - 990. [Full Text] [PDF]

				B Guthrie, T Love, T Fahey, A Morris, and F Sullivan Control, compare and communicate: designing control charts to summarise efficiently data from multiple quality indicators Qual. Saf. Health Care, December 1, 2005; 14(6): 450 - 454. [Abstract] [Full Text] [PDF]

				F. Lacour-Gayet, J. P. Jacobs, D. R. Clarke, J.W. Gaynor, M. L. Jacobs, R. H. Anderson, M. J. Elliott, B. Maruszewski, P. Vouhe, and C. Mavroudis Performance of surgery for congenital heart disease: Shall we wait a generation or look for different statistics? J. Thorac. Cardiovasc. Surg., July 1, 2005; 130(1): 234 - 235. [Full Text] [PDF]

				B. Bridgewater and on behalf of the adult cardiac surgeons of north w Mortality data in adult cardiac surgery for named surgeons: retrospective examination of prospectively collected data on coronary artery surgery and aortic valve replacement BMJ, March 5, 2005; 330(7490): 506 - 510. [Abstract] [Full Text] [PDF]