Using risk-adjusted cumulative sum to evaluate surgeon, divisional, and institutional outcomes-a feasibility study

Area of Science:

• Surgical Quality Improvement
• Health Services Research
• Medical Data Analytics

Background:

• Objective, real-time measurement of surgeon performance is limited.
• Risk-adjusted cumulative sum (RA CUSUM) offers a novel method for continuous tracking of surgeon-level outcomes.
• The need for effective tools to monitor surgical quality and identify performance variations is critical.

Purpose of the Study:

• To demonstrate the feasibility of using RA CUSUM for monitoring outcomes in colorectal surgery.
• To identify clinically relevant performance variations among surgeons.
• To evaluate the utility of RA CUSUM in a real-world surgical setting.

Main Methods:

• Utilized National Surgical Quality Improvement Program (NSQIP) data for 1,603 colorectal operations (2011-2020).
• Estimated patient-specific risks for morbidity, mortality, reoperation, readmission, and prolonged length of stay using the NSQIP risk calculator.
• Generated RA CUSUM curves with thresholds for poor (observed-to-expected odds ratio > 1.5) and exceptional (odds ratio < 0.5) performance, with control limits set at α = 0.05.

Main Results:

• Analysis included 7 surgeons with >20 cases; institutional outcomes showed favorable comparisons to expected rates (e.g., morbidity 12.5% vs. 15.0%).
• RA CUSUM effectively demonstrated within- and between-surgeon performance variations across key metrics.
• The method proved effective for both individual surgeon and division-level performance analysis.

Conclusions:

• RA CUSUM provides real-time, risk-adjusted data on surgeon-specific outcomes.
• This approach facilitates prompt identification of performance outliers for quality assurance and root-cause analysis.
• RA CUSUM supports quality initiatives at surgeon, divisional, and institutional levels.