Monitoring surgical performance using risk-adjusted cumulative sum charts.


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.

Extracted Key Phrases

4 Figures and Tables

Citations per Year

960 Citations

Semantic Scholar estimates that this publication has 960 citations based on the available data.

See our FAQ for additional information.

Cite this paper

@article{Steiner2000MonitoringSP, title={Monitoring surgical performance using risk-adjusted cumulative sum charts.}, author={S H Steiner and R J Cook and V T Farewell and T Treasure}, journal={Biostatistics}, year={2000}, volume={1 4}, pages={441-52} }