| CUSUM analysis of J-pouch surgery reflects no learning curve after board certification. | |
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MedLine Citation:
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PMID: 18815654 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Patrick H D Colquhoun |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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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:
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Created Date: 2008-09-25 Completed Date: 2008-10-07 Revised Date: 2013-06-05 |
Medline Journal Info:
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Nlm Unique ID: 0372715 Medline TA: Can J Surg Country: Canada |
Other Details:
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Languages: eng Pagination: 296-9 Citation Subset: IM |
Affiliation:
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London Health Sciences Centre, University Hospital, London, Ont. patrick.colquhoun@lhsc.on.ca |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Clinical Competence* Colonic Diseases / epidemiology, surgery* Colonic Pouches / standards* Education, Medical, Continuing / standards* Educational Measurement / methods* Female Humans Male Middle Aged Morbidity Ontario / epidemiology Outcome Assessment (Health Care)* Prospective Studies Severity of Illness Index Specialty Boards* Survival Rate / trends |
| Comments/Corrections | |
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