Time to CUSUM: simplified reporting of outcomes in colorectal surgery

Surgical audit has added value when outcomes can be compared and individual surgeons receive feedback. It is expected that surgeons compare their results with others in similar local practice, the published work, or peers from a craft group audit. Although feedback and comparison are worthy aims, for many surgeons the standards have not been agreed nor is there a craft group audit. The aim of this paper was to develop a reporting format for surgeons carrying out colorectal surgery in a regional hospital. The performance of 13 individual surgeons was analysed using a comprehensive colorectal audit with more than 600 cases. Feedback included caseload and type. Risk stratification of outcomes included; operation urgency, age and Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity. Outcome measures were anastomotic leaks, end stoma rates, unplanned reoperations and mortality. Visual feedback included cumulative summation graphs for elective leaks, mortality and unplanned reoperations. A single A4 page of an individuals performance could be prepared that allowed comparison to the groups data overall. Alerts were set at 2-5% elective leaks, 4-7.5% mortality and 4-11% unplanned return to theatre. Cumulative summation graphs added to this allowed a visual guide to the key performance indicators. Surgeons need to determine how they will review their individual and collective results. These are equally important to the reported work. Detailed analysis of risk-stratified data should occur. Binary outcomes such as leak, mortality and unplanned reoperations may be followed by cumulative summation graphs. This provides a continually updated method of feedback, enabling immediate visual feedback of a surgeon's performance.