Quality assessment of donor liver procurement surgery using an unadjusted CUSUM prediction model. A practical nationwide evaluation

Abstract

Background The aim of this study was to analyze the value of the unadjusted CUSUM graph of liver surgical injury and discard rates in organ procurement in the Netherlands. Methods Unadjusted CUSUM graphs were plotted for surgical injury (C event) and discard rate (C2 event) from procured livers accepted for transplantation for each local procurement team compared with the total national cohort. The average incidence for each outcome was used as benchmark based on procurement quality forms (Sep 2010–Oct 2018). The data from the five Dutch procuring teams were blind‐coded. Results The C and C2 event rate were 17% and 1.9%, respectively (n = 1265). A total of 12 CUSUM charts were plotted for the national cohort and the five local teams. National CUSUM charts showed an overlapping “alarm signal.” This overlapping signal for both C and C2, albeit a different time period, was only found in one local team. The other CUSUM alarm signal went off for two separate local teams, but only for C events or C2 events respectively, and at different points in time. The other remaining CUSUM charts showed no alarm signaling. Conclusion The unadjusted CUSUM chart is a simple and effective monitoring tool in following performance quality of organ procurement for liver transplantation. Both national and local recorded CUSUMs are useful to see the implication of national and local effects on organ procurement injury. Both procurement injury and organ discard are equally important in this analysis and need to be separately CUSUM charted.

Ten Years of Quality Monitoring of Abdominal Organ Procurement in the Netherlands and Its Impact on Transplant Outcome

“…Although center volume was not specifically addressed in this study, de Boer et al showed that centers performing more procurements had significantly fewer injuries (C1+ C2) for kidney and pancreatic procurement [ 3 ]. In 2023 Lam et al suggested that cumulative sum (CUSUM) analysis plots with data from the Quality Forms could be of value to prospectively monitor procurement-related injury in a real-time manner, which could further lead to quality improvement and bring quality monitoring to a new level [ 23 ].…”

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“…Although center volume was not specifically addressed in this study, de Boer et al showed that centers performing more procurements had significantly fewer injuries (C1+ C2) for kidney and pancreatic procurement [3]. In 2023 Lam et al suggested that cumulative sum (CUSUM) analysis plots with data from the Quality Forms could be of value to prospectively monitor procurement-related injury in a real-time manner, which could further lead to quality improvement and bring quality monitoring to a new level [23].…”