JTCS Speed Up Your Browser
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Stephan Jacobs
Thomas Walther
Michael Mochalski
Friedrich W. Mohr
Volkmar Falk
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Holzhey, D. M.
Right arrow Articles by Falk, V.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Holzhey, D. M.
Right arrow Articles by Falk, V.
Related Collections
Right arrow Minimally invasive surgery

J Thorac Cardiovasc Surg 2007;134:663-669
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Cumulative sum failure analysis for eight surgeons performing minimally invasive direct coronary artery bypass

David M. Holzhey, MD*, Stephan Jacobs, MD, Thomas Walther, MD, PhD, Michael Mochalski, MD, Friedrich W. Mohr, MD, PhD, Volkmar Falk, MD, PhD

Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.

Received for publication November 11, 2006; revisions received March 14, 2007; accepted for publication March 20, 2007.

* Address for reprints: David M. Holzhey, MD, Herzzentrum Leipzig, Strümpellstraße 39 04289 Leipzig, Germany. (Email: dholzhey{at}web.de).

Objective: Analysis of average and individual surgical performance for minimally invasive direct coronary artery bypass was used to enhance quality control for that operation.

Methods: A total of 1441 standard minimally invasive direct coronary artery bypass procedures performed from August 1996 to January 2006 were analyzed for mortality and 10 other major perioperative complications. Learning curves and assessment of perioperative outcome were calculated using descriptive statistics and cumulative sum observed minus expected failure analysis for 8 involved surgeons with a personal experience ranging from 27 to 443 procedures.

Results: The incidence of in-hospital mortality was 0.9% and compared favorably with the predicted mortality calculated by the logistic EuroSCORE (3.6%, P < .01). Cumulative sum analysis revealed that 2 surgeons crossed the 95% reassurance boundary after 50 operations and that 2 surgeons crossed the 95% reassurance boundary after 100 operations. There were significant differences between surgeons with regard to the learning curves and perioperative complications (3.6%–29.6%, P < .01). Two surgeons crossed the 95% alarm-line indicating unacceptably high failure rates.

Conclusions: Minimally invasive direct coronary artery bypass has become a procedure with low mortality and low complication rates, but results are case-load and surgeon dependent. Cumulative sum analysis is a valuable method allowing for a breakdown of complication rates over time displaying individual surgeons’ strengths.

Abbreviations and Acronyms CUSUM = cumulative sum; MIDCAB = minimally invasive direct coronary artery bypass






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2007 by The American Association for Thoracic Surgery.