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. 2023 Apr 6:14:252-260.
doi: 10.1016/j.xjon.2023.03.012. eCollection 2023 Jun.

Quality control in a training course of off-pump coronary artery bypass grafting surgery

Zengqiang Han  1 , Zhou Zhao  1 , Guodong Zhang  2 , Wenqiang Sun  3 , Yu Chen  1
Affiliations

Quality control in a training course of off-pump coronary artery bypass grafting surgery

Zengqiang Han et al. JTCVS Open. .

Abstract

Objectives: Off-pump coronary artery bypass grafting (OPCAB) surgery is controversial in part because of the surgeon's experience, which correlates with how the surgeon is trained. Because the training model of OPCAB is not uniform, the quality control in the training process seems to be more important and needs to be further discussed.

Methods: Nine surgeons accepted and completed an OPCAB training course at a single center to become independent surgeons. This training program is characterized by 6 progressive levels supervised by experienced trainers. In total, 2307 consecutive cases of OPCAB performed by the 9 trainee surgeons were analyzed for monitoring and evaluation in quality control. The funnel plots and cumulative summation (CUSUM) analysis method were used to evaluate the performance of each surgeon.

Results: The mortality and complications of each surgeon were all within the 95% confidence interval of funnel plots. The CUSUM learning curves of first 3 trainees was analyzed and showed that the trainees need to complete approximately 65 cases to cross the CUSUM learning curve to reach a steady state.

Conclusions: The trainees can directly receive the OPCAB training course under the guidance of experienced surgeons with a rigorous schedule. It is feasible to perform quality control by funnel plots and CUSUM method in OPCAB surgery to ensure the safety of the training course.

Keywords: CUSUM failure analysis; funnel plots; off-pump coronary artery bypass grafting; quality control.

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Figures

None
Live off-pump animal experiment.
Figure 1
Figure 1
Funnel plot showing the operative mortality of different surgeons.
Figure 2
Figure 2
A-D, funnel plots showing the major operative complications of different surgeons. CVVH, Continuous venovenous hemofiltration.
Figure 3
Figure 3
A, B, The quality assessment by CUSUM method in mature and stable group. CUSUM, Cumulative summation.
Figure 4
Figure 4
A-C, The CUSUM learning curve of surgeons A-C. CUSUM, Cumulative summation.
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