Safe Launching of a Newly Appointed Cardiac Surgery Unit at a Low-Volume Hospital With the Use of Cumulative Sum Analysis

Abstract

Background Few studies have used the cumulative sum method to examine the initial performance of a newly appointed cardiac surgery team at a low-volume hospital. Methods and Results In the 4 years from April 2002 to December 2006, 274 cases of open-heart surgery were performed and the overall mortality and morbidity rates were 4.01% and 5.84%, respectively. The respective rates for coronary, valvular and aortic surgery were 2.05% and 2.74%, 3.61% and 7.23%, and 11.1% and 13.3%. The overall cumulative sum curve was below the 80% upper alarm line since the 58^th case and below the 80% lower alarm line since the 139^th case. The respective values for the cumulative sum curves of valvular and coronary surgery were the 1^st and 41^st cases, the 22^nd and the 76^th cases, but for aortic surgery the cumulative sum curve remained below the 80% upper alarm line since the 1^st case but did not reach below the 80% lower alarm line Conclusions An open-heart surgery unit at a low-volume hospital could compete with a high-volume hospital if it has a safe launching and low mortality and morbidity rates. The predictor of a safe launching is not the annual volume, but the cumulative experience of the surgical team. (Circ J 2008; 72: 437 - 440)