Perception and reporting of cardiac surgical performance.
The high level of interest in surgical outcomes has led to the publication of mortality rates in the public domain. In cardiac surgery, the availability of quite sophisticated risk assessment has allowed these outcomes to be adjusted for risk. The European System for Cardiac Operative Risk Evaluation is a widely recognized and used risk scoring system and has been used and validated throughout Europe and beyond. The logistic version is now the most commonly applied, but recalibration may be required. The methodology and statistics for measuring risk-adjusted performance are available, and regular audit and performance monitoring should be carried out in all cardiac surgical units. In the United Kingdom, risk-adjusted outcomes are available and regularly updated on the Internet. Presentation of data may be improved by the use of variable life-adjusted display curves. League tables for crude mortality can be misleading and should be avoided. When properly conducted, the measurement of risk-adjusted surgical outcomes should improve quality control and decision making and allow early identification of poor performance. Quality monitoring in medicine is a priority, and similar methods can be employed in other specialties, including anesthesia, by establishing and analyzing risk-stratified outcome data sets.
Klein
Andrew A
AA
Department of Anesthesia, Papworth Hospital, Cambridge, United Kingdom. Andrew.Klein@papworth.nhs.uk
Nashef
Samer A M
SA
D000068:Accreditation; D000465:Algorithms; D000818:Animals; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D003627:Data Interpretation, Statistical; D006801:Humans; D015233:Models, Statistical; D011785:Quality Assurance, Health Care; D018570:Risk Assessment