Use of statistical process control in quality improvement projects in abdominal surgery: a PRISMA systematic review

Area of Science:

• Surgical Quality Improvement
• Healthcare Analytics
• Medical Statistics

Background:

• Quality improvement methodologies are increasingly adopted to reduce patient morbidity, mortality, and hospital stay.
• Statistical Process Control (SPC) is a key tool for evaluating quality improvement but has limited documented use in abdominal surgery.
• Previous systematic reviews on SPC in healthcare identified few surgery-specific studies.

Approach:

• A systematic review was conducted to assess the application of SPC in abdominal surgery specialties from 2004 to 2019.
• Literature searches were performed using Embase and Ovid Medline with relevant keywords.
• The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Key Points:

• Twenty articles met the inclusion criteria, with most originating from North America, Europe, and Australia.
• Surgical complications were the most frequently studied outcomes, with urology, colorectal, and pediatric surgery being prominent specialties.
• While SPC demonstrated flexibility across various outcomes and graph types, some studies exhibited methodological weaknesses and variable quality.

Conclusions:

• SPC application is growing in surgical fields but lags behind areas like anesthesia.
• Identified conceptual and analytical errors in several studies highlight the need for improved SPC implementation.
• Enhanced analytical rigor in SPC is crucial for accurate quality improvement in surgical care.