Abstract
203 Background: CUSUM analysis is an analytic tool for monitoring institutional quality and clinical outcomes. CUSUM is a summative plot of an event that occurs over time. The slope that is generated can be used to determine rates of occurrence and deviations from an accepted rate. CUSUM can be used to monitor mortality rates following esophagectomy. Methods: A single institution prospectively maintained esophageal disease registry was used to construct CUSUM plots for in-hospital and 30-day mortality. All patients undergoing esophagectomy with reconstruction from 1995-2015 were included for analysis. Time points that deviated from an accepted mortality rate of 5% were evaluated for cause analysis. Results: From 1995-2015, 485 esophagectomies were performed with a cumulative in-hospital mortality rate of 4.7%. In 2008 our institution shifted to a primarily minimally invasive approach. Prior to March 2008 in-hospital mortality was 7.4%. After this time, in-hospital mortality was 2.1%, corresponding with a decreased slope of the CUSUM plot. A second period was investigated from September 2012-October 2012. Eight esophagostomies were performed with 3 deaths for a 37.5% mortality rate. All 3 patients were deaths related to ARDS and multisystem organ failure; this prompted an institutional epidemiologic investigation, as well as review of our enhanced esophageal recovery pathway. Since this time frame in-hospital mortality has been 1%. Conclusions: CUSUM analysis offers a useful observational tool to monitor institutional quality following esophagectomy. Investigations into mortality can identify quality problems and can lead to implementation of improved process measures that may lead to improved future outcomes.
Published Version
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