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Debate: what is the best method to monitor surgical performance?

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art%3A10.1186%2Fs12893-016-0131-8.pdf (531.54 KB)

Date

2016-04-05

Authors

Woodall, William
Steiner, Stefan H.

Journal Title

Journal ISSN

Volume Title

Publisher

BioMed Central

Abstract

Background There is considerable recent interest in the monitoring of individual surgeon or hospital surgical outcomes. If one aggregates data over time and assesses performance with a funnel plot, then the detection of any process deterioration or improvement could be delayed. The variable life adjusted display (VLAD) is widely used for monitoring on a case-by-case basis, but we show that use of the risk-adjusted Bernoulli cumulative sum (RA-CUSUM) chart leads to much better performance. Discussion We use simulation to illustrate that the RA-CUSUM chart has better performance than the VLAD in detecting changes in the rates of adverse events. Summary We recommend the RA-CUSUM approach over the VLAD approach for monitoring surgical performance. If the VLAD is used, we recommend running the RA-CUSUM chart in the background to generate signals that the process performance has changed.

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Keywords

Debate, Surgical outcomes, Monitoring, Variable life adjusted display (VLAD), Risk-adjusted Bernoulli cumulative sum (RA-CUSUM)

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Citation

URI

https://doi.org/10.1186/s12893-016-0131-8
 http://hdl.handle.net/10012/11739

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Waterloo Research
Statistics and Actuarial Science