title: CUSUM analysis of J-pouch surgery reflects no learning curve after board certification.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: London Health Sciences Centre, University Hospital, London, Ont. patrick.colquhoun@lhsc.on.ca
authors.forename: Patrick H D
authors.initials: PH
authors.lastname: Colquhoun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002983:Clinical Competence; D003108:Colonic Diseases / Q000453:epidemiology / Q000601:surgery*; D039021:Colonic Pouches / Q000592:standards*; D004502:Education, Medical, Continuing / Q000592:standards*; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009864:Ontario / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012720:Severity of Illness Index; D013044:Specialty Boards; D015996:Survival Rate / Q000639:trends