Monitoring surgical performance using risk-adjusted cumulative sum charts.
Monitoring surgical performance using risk-adjusted cumulative sum charts.
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DOI：
10.1093/biostatistics/1.4.441
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发表时间：
2000-12-01
期刊：
影响因子：
--
通讯作者：
Treasure, T
中科院分区：
文献类型：
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作者：
Steiner, S H;Cook, R J;Treasure, T
累积和（CUSUM）程序是一种广泛用于工业环境中质量监测的图形方法。最近，它被用于监测手术结果，如果有足够的证据表明手术失败率发生了变化，它就会发出“信号”。在这种情况下，标准CUSUM程序的一个局限性是，由于它只是基于观察到的手术结果，它可能表明转诊模式的变化，例如高风险患者比例的增加，而不是由于实际手术表现的变化。我们描述了一种新的CUSUM程序，通过使用基于可能性的评分方法来调整每个患者术前手术失败的风险。因此，该程序非常适合患者随时间变化的情况。
The cumulative sum (CUSUM) procedure is a graphical method that is widely used for quality monitoring in industrial settings. More recently it has been used to monitor surgical outcomes whereby it 'signals' if sufficient evidence has accumulated that there has been a change in the surgical failure rate. A limitation of the standard CUSUM procedure in this context is that since it is simply based on the observed surgical outcomes, it may signal as a result of changes in the referral pattern, such as an increased proportion of high-risk patients, rather than due to a change in the actual surgical performance. We describe a new CUSUM procedure that adjusts for each patient's pre-operative risk of surgical failure through the use of a likelihood-based scoring method. The procedure is therefore ideally suited for settings where there is a variable mix of patients over time.