Development of a Charting Method to Monitor the Individual Performance of Surgeons at the Beginning of Their Career

Details

Serval ID
serval:BIB_BD48AB4111D7
Type
Article: article from journal or magazin.
Collection
Publications
Title
Development of a Charting Method to Monitor the Individual Performance of Surgeons at the Beginning of Their Career
Journal
PLoS ONE
Author(s)
Duclos Antoine, Carty Matthew J., Peix Jean-Louis, Colin Cyrille, Lipsitz Stuart R., Kraimps Jean-Louis, Menegaux Fabrice, Pattou François, Sebag Fréderic, Voirin Nicolas, Touzet Sandrine, Bourdy Stéphanie, Lifante Jean-Christophe
Working group(s)
CATHY Study Group
ISSN
1932-6203
Publication state
Published
Issued date
31/07/2012
Peer-reviewed
Oui
Editor
Steyerberg Ewout W.
Volume
7
Number
7
Pages
e41944
Language
english
Notes
Research Support, Non-U.S. Gov't
Multicenter Study
Abstract
Background: Efforts to provide a valid picture of surgeons' individual performance evolution should frame their outcomes in relation to what is expected depending on their experience. We derived the learning curve of young thyroidectomy surgeons as a baseline to enable the accurate assessment of their individual outcomes and avoid erroneous conclusions that may derive from more traditional approaches.
Methods: Operative time and postoperative recurrent laryngeal nerve palsy of 2006 patients who underwent a thyroidectomy performed by 19 young surgeons in five academic hospitals were monitored from April 2008 to December 2009. The database was randomly divided into training and testing datasets. The training data served to determine the expected performance curve of surgeons during their career and factors influencing outcome variation using generalized estimating equations (GEEs). To simulate prospective monitoring of individual surgeon outcomes, the testing data were plotted on funnel plots and cumulative sum charts (CUSUM). Performance charting methods were utilized to present outcomes adjusted both for patient case-mix and surgeon experience.
Results: Generation of performance curves demonstrated a gradual reduction in operative time from 139 (95% CI, 137 to 141) to 75 (71 to 80) minutes, and from 15.7% (15.1% to 16.3%) to 3.3% (3.0% to 3.6%) regarding the nerve palsy rate. Charts interpretation revealed that a very young surgeon had better outcomes than expected, whereas a more experienced surgeon appeared to be a poor performer given the number of years that he had already spent in practice.
Conclusions: Not considering the initial learning curve of surgeons exposes them to biased measurement and to misinterpretation in assessing their individual performance for thyroidectomy. The performance chart represents a valuable tool to monitor the outcome of surgeons with the expectation to provide safe and efficient care to patients.
Competing Interests: The authors have declared that no competing interests exist.
Keywords
Cross-Sectional Studies, General Surgery, Medical Records, Prospective Study, Task Performance and Analysis, Thyroidectomy Vocal Cord Paralysis, Workforce, Surgical performance, Outcome research, Health services research, Learning curve, Patient safety, postoperative complications
Pubmed
Web of science
Open Access
Yes
Funding(s)
Other
Create date
03/11/2023 16:12
Last modification date
07/11/2023 8:11
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