Tailor-made proficiency curves in laparoscopic hysterectomy: enhancing patient safety using CUSUM analysis

The objective of this study is to develop a risk-adjusted real-time quality control system in laparoscopic hysterectomy with respect to blood loss, operative time and adverse events in order to signal derailing surgical performance in a timely fashion. Based on prior research, uterus weight, body mass index, number of surgeons, prior abdominal surgery, and type of laparoscopic hysterectomy were identified as significant covariates predicting successful surgical outcome. Cumulative sum (CUSUM) analysis, a model based on dichotomous input (success or “failure”), was selected as a predictive tool for performance analysis. Cutoff values were set at blood loss