The proposed risk-adjusted cumulative sum chart provides a method to prospectively monitor surgical performance and rapidly detect changes in failure rates while accounting for patient case-mix.
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May aid real-time risk-adjusted surgical monitoring; leaves open prospective validation before clinical adoption.
A graphical procedure suitable for prospectively monitoring surgical performance is proposed.The approach is based on accumulating evidence from the outcomes of all previous surgical patients in a series using a new type of cumulative sum chart.Cumulative sum procedures are designed to "signal" if sufficient evidence has accumulated that the surgical failure rate has changed substantially.In this way, the chart rapidly detects deterioration (or improvement) in surgical performance, while not over reacting to the expected fluctuations due to chance.Through the use of a likelihood-based scoring method, the cumulative sum procedure is adapted so that it adjusts for the surgical risk of each patient estimated pre-operatively.The procedure is therefore applicable in situations where it is desirable to adjust for a mix of patients.Signals of the chart lead to investigations of the cause and to the timely introduction of remedial measures designed to avoid unnecessary future failures.
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Steiner et al. (2001) studied this question.
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