Surgeon performance index: tool for assessment of individual surgical quality in total quality management

Abstract

The surgeon's individual performance is a key component of total quality management (TQM) in cardiac surgery. Early mortality as well as postoperative complications can be stratified in order to develop a surgeon performance index (SPI). In three consecutive annual periods (3703 patients) data of board-certified cardiac surgeons were compared. Risk-adjustment of early mortality and postoperative complications was performed by logistical EuroSCORE (logES). Early mortality (EM), early rethoracotomy for bleeding (ReTh), sternal rewiring for instability (ReWr), and mediastinitis (Med) were assessed. ReTh, ReWr, and Med were weighted according to empiric data: (ReThx2; ReWrx1; Medx3). Surgeon performance index was computed as follows: SPI=(EM/logES+[((ReTh/logES)x2)+((ReWr/logES)x1)+((Med/logES)x3)]/6)/2. Ideal SPI was considered <or=1. SPI of the respective previous period was handed out to each surgeon and discussed by means of a structured dialogue. Patients from each period were allocated to 11 cardiac surgeons. Overall logES of the three periods were 6.6%, 9.1%, and 11.2% respectively; EM 5.7%, 6.6%, 5.6%; ReTh 5.8%, 7.3%, 10.9%; ReWr 2.4%, 1.9%, 1.4%; and Med 0.9%, 1.8%, 1.8%. SPI showed a mean of 0.71, 0.56, and 0.49. Comorbidity increased between periods 1 and 3 significantly whereas early mortality remained rather stable. SPI indicated improvement of the performance of the individual surgeon and a decrease of range and mean of the overall performance. SPI is therefore an effective tool to assess individual surgical quality and serves as an instrument for human resource management and development. Sustainable positive effects on overall performance can be expected.