Risk-adjusted monitoring of surgical performance

Jianbo Li, Jiancheng Jiang, Xuejun Jiang and Lin Liu

PLOS ONE, 2018, vol. 13, issue 8, 1-13

Abstract: We propose a nonparametric risk-adjusted cumulative sum chart to monitor surgical outcomes for patients with different risks of post-operative mortality due to risk factors that exist before the surgery. Using varying-coefficient logistic regression models, we accomplish the risk adjustment. Unknown coefficient functions are estimated by global polynomial spline approximation based on the maximum likelihood principle. We suggest a bisection minimization approach and a bootstrap method to determine the chart testing limit value. Compared with the previous (parametric) risk-adjusted cumulative sum chart, a major advantage of our method is that the morality rate can be modeled more flexibly by related covariates, which significantly enhances the monitoring efficiency. Simulations demonstrate nice performance of our proposed procedure. An application to a UK cardiac surgery dataset illustrates the use of our methodology.

Date: 2018
References: View references in EconPapers View complete reference list from CitEc
Citations:

Downloads: (external link)
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200915 (text/html)
https://journals.plos.org/plosone/article/file?id= ... 00915&type=printable (application/pdf)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0200915

DOI: 10.1371/journal.pone.0200915

Access Statistics for this article

More articles in PLOS ONE from Public Library of Science
Bibliographic data for series maintained by plosone ().