RT Journal Article
SR Electronic
T1 CUSUM analysis of J-pouch surgery reflects no learning curve after board certification
JF Canadian Journal of Surgery
JO CAN J SURG
FD Canadian Medical Association
SP 296
OP 299
VO 51
IS 4
A1 Colquhoun, Patrick H.D.
YR 2008
UL http://canjsurg.ca/content/51/4/296.abstract
AB Objective: To investigate changes in morbidity and mortality associated with ileal J-pouch surgery performed during the first 3 years of a single surgeon’s practice to determine the presence or absence of a learning curve after fellowship training.Methods: From July 2002 to July 2005, an observational study of postoperative outcomes was undertaken, in which 30-day and inhospital morbidity and mortality were assessed. A total of 37 patients (17 women and 20 men) underwent the surgery; their average age was 32 (range 16–51) years. The operation was performed for ulcerative colitis (n = 31), familial adenomatous polyposis (n = 4) and indeterminate colitis (n = 2); 32 were diverted and 5 were not. Predicted morbidity and mortality were 31.66% and 1.47%, respectively. Observed morbidity and mortality were 29.7% and 0%, respectively. I used a risk-adjusted cumulative sum (CUSUM) model to compare observed outcomes with predicted outcomes according to a validated scoring system and to analyze outcomes with adjusting for risk on a case-by-case basis.Results: CUSUM analysis revealed a flat curve trending down over the duration.Conclusion: CUSUM methodology permits documentation of quality control during the first 3 years of practice. The experience of a single board-certified colorectal surgeon reveals acceptable results in the first 3 years of practice, with no obvious learning curve. The results suggest that fellowship training and board certification conferred reasonable proficiency in J-pouch surgery before the onset of practice.