title: A learning curve in aortic dissection surgery with the use of cumulative sum analysis.
abstract: This study demonstrates the risk adjusted cumulative sum analysis of an individual surgical learning curve for acute type A aortic dissection surgery. Thirty consecutive patients were operated by a single surgeon for acute type A aortic dissection from April 2001 to March 2008. Operative variables, mortality, and major morbidities were analyzed. The learning curve was calculated by cumulative sum analysis. The anticipated 30-day operative mortality rate was 20.2 +/- 12.7% (range, 3.3-56.7%) and the expected 30-day mortality and morbidity rate was 47.0 +/- 13.3% (range, 21.7-70.6%) according to the Japan SCORE calculator. The observed operative and in-hospital mortality rate was 6.67% (two patients), and the observed major postoperative morbidity rate was 10.0% (three patients). Risk-adjusted cumulative sum analysis revealed that no excess deaths occurred beginning at the seventh case and thereafter. The surgeries for acute type A aortic dissection could be performed at the professionally permissive level from the beginning. Risk-adjusted cumulative sum analysis was a useful tool to monitor the performance of the surgical procedure.
authors.forename: Min-Ho
authors.initials: MH
authors.lastname: Song
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D002983:Clinical Competence; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D019984:Quality Indicators, Health Care; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality