Cumulative Sum Techniques for Surgeons: A Brief Review

Abstract

There has been increasing awareness of the need for monitoring the quality of health care, particularly in the area of surgery. The Cumulative Summation (Cusum) techniques have emerged as a popular tool for performance monitoring in surgery. They allow one to judge whether a given variation in performance is probably due to chance or greater than could be expected from random variation and thus a cause for concern. The Cusum techniques are simple to carry out and can be applied to any surgical process with a binary outcome. Four parameters need to be set in advance: acceptable outcome rate, unacceptable outcome rate, Type I and Type II error rates. In this article, we review the history, statistical methods and potential applications for the Cusum techniques in the field of surgery and illustrate the two common forms of charting (cumulative failure and Cusum charting) by using unadjusted outcome data from the Geelong Hospital and St Vincent's Hospital cardiac surgery databases.

Accelerated learning curve for colorectal resection, open versus laparoscopic approach, can be attained with expert supervision

“…CUSUM curve has emerged as a popular tool to monitor quality of surgery [16]. CUSUM allows one to judge whether a given variation in performance is acceptable, or whether the variation is greater than could be expected from random variation and thus may be a concern.…”

Preoperative Risk Stratification for Mortality and Major Morbidity in Major Colorectal Surgery

“…[11][12][13][14] It would be desirable to further rationalize the risk factor dataset to simple preoperative variables in hopes of achieving similar efficacy. This study aims to identify preoperative risk factors of major colorectal operations for mortality and major morbidity outcomes.…”

Learning curves of novice anesthesiology residents performing simulated fibreoptic upper airway endoscopy

“…[17][18][19] Reports in the available literature regarding the minimum number of cases required to complete a training module in gastrointestinal endoscopy, 8,9 pulmonary bronchoscopy, 7 and anesthesiarelated procedures 10,14 are not based on objective criteria. Statistical process control techniques, [20][21][22][23] such as CUSUM analysis, can be used to examine objectively the sequence of successes and failures in performing a task repetitively. The CUSUM analysis has been used previously in anesthesiology and is employed in the present study.…”