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Cumulative sum techniques for assessing surgical results

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Background

CUSUM analysis was introduced 50 years ago in the United Kingdom (UK) using the terminology of industrial quality control [5], and was first used to monitor surgical performance 10 years ago [6]. Since then, several authors from the UK have extended the theory to accommodate the varying risk of cardiac surgery mortality 7, 8, 9, 10, 11, 12, 13

Comment

Cumulative sum techniques are an informative, visually helpful tool for presenting data and studying trends. CUSUM is a 50-year-old method that has been used on cardiac surgery mortality for the past 10 years. Treasure and associates [21]22 recently wrote an overview that covers much of the material in this study, and Grigg and colleagues [13] provide a thorough review on a more technical level.

Acknowledgements

The authors are grateful to Jeanne Zerr for guidance on content, to Ling Zhang for clerical support and to the following PHS hospitals for sharing their coronary bypass surgery data: Alaska: Providence Anchorage Medical Center; Washington: Providence Everett Medical Center, Providence Campus, Swedish Medical Center (Seattle), Providence St. Peter Hospital (Olympia), Providence Yakima Medical Center (Yakima); Oregon: Providence Portland Medical Center, Providence St. Vincent Medical Center

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References (22)

  • C. Sherlaw-Johnson et al.

    Likely variations in perioperative mortality associated with cardiac surgerywhen does high mortality reflect bad practice?

    Heart

    (2000)
  • Cited by (80)

    • Continuous Monitoring of Risk-Adjusted Outcomes: Excess Deaths vs Lives Saved

      2021, Annals of Thoracic Surgery
      Citation Excerpt :

      The vertical difference at any point between the 2 lines (CUSUM of O and CUSUM of E) in Figure 2 is the CUSUM of the individual O minus E patient values, shown in Figure 3. When the continuous summation of these individual O minus E results are graphed over time, it results in a Risk-Adjusted CUSUM (RA-CUSUM) plot,6 also called a Cumulative Risk-Adjusted Mortality (CRAM) plot.7 Graphically tracking this CUSUM difference over time provides a visual representation of the continuous O minus E trajectory in real-time.

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