title: Application of Variable Life Adjusted Display (VLAD) to risk-adjusted mortality of esophagogastric cancer surgery.
abstract: OBJECTIVE
  In the new era of revalidation, there is an increasing need to measure surgical outcome objectively. We apply a graphical method, the Variable Life Adjusted Display (VLAD), to esophagogastric resection for malignancy. This technique charts the cumulative difference between expected and actual risk-adjusted mortality over time, allowing observation of performance trends irrespective of case-mix.
  
  
  METHODS
  P-POSSUM was applied retrospectively to 182 consecutive patients who underwent resection for esophageal or gastric malignancy in a district general hospital. The primary outcome measured was 30-day mortality.
  
  
  RESULTS
  A total of 168 patients were eligible for inclusion, with a median age of 68 years. The overall 30-day mortality rate was 4.2% compared with 7.1% as predicted by P-POSSUM. The resulting VLAD plot demonstrates an upward trend of better than predicted surgical performance.
  
  
  CONCLUSIONS
  VLAD has been hereby applied to esophagogastric surgery and has graphically demonstrated risk-adjusted trends in a single general surgeon's performance. For qualitative comparative purposes, including recertification, VLAD is judged to be a simple, directly interpretable, and useful technique for monitoring surgical performance.
authors.affiliation: Department of Surgery, Dumfries and Galloway Royal Infirmary, Bankend Road, Dumfries, DG1 4AP, UK. rvguest@doctors.org.uk
authors.forename: R V
authors.initials: RV
authors.lastname: Guest
authors.forename: V V
authors.initials: VV
authors.lastname: Chandrabalan
authors.forename: G D
authors.initials: GD
authors.lastname: Murray
authors.forename: C D
authors.initials: CD
authors.lastname: Auld
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000401:mortality / Q000592:standards*; D005260:Female; D005743:Gastrectomy / Q000401:mortality / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020379:Risk Adjustment / Q000379:methods*; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome