Document Detail

CUSUM analysis of J-pouch surgery reflects no learning curve after board certification.
MedLine Citation:
PMID:  18815654     Owner:  NLM     Status:  MEDLINE    
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.
Patrick H D Colquhoun
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Canadian journal of surgery. Journal canadien de chirurgie     Volume:  51     ISSN:  1488-2310     ISO Abbreviation:  Can J Surg     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-09-25     Completed Date:  2008-10-07     Revised Date:  2013-06-05    
Medline Journal Info:
Nlm Unique ID:  0372715     Medline TA:  Can J Surg     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  296-9     Citation Subset:  IM    
London Health Sciences Centre, University Hospital, London, Ont.
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MeSH Terms
Clinical Competence*
Colonic Diseases / epidemiology,  surgery*
Colonic Pouches / standards*
Education, Medical, Continuing / standards*
Educational Measurement / methods*
Middle Aged
Ontario / epidemiology
Outcome Assessment (Health Care)*
Prospective Studies
Severity of Illness Index
Specialty Boards*
Survival Rate / trends

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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