HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Luc Noyez Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Noyez, L. Search for Related Content PubMed Articles by Noyez, L.

Editorial comment

Quality measurement in adult cardiac surgery: a challenge

Heart Center, Radboud University Nijmegen, Department of Cardio-Thoracic Surgery – 677, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands

^_* Corresponding author. Address: Heart Center, Radboud University Nijmegen, Department of Cardio-Thoracic Surgery – 677, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. Tel.: +31 24 3613711; fax: +31 24 3540129. (Email: l.noyez@thorax.umcn.nl).

Key Words: Cardiac surgery • Quality control • Outcome measures

The first 20% of the full text of this article appears below.

	Introduction

 
The manuscript presented by Hartrumpf et al. concerns a current but sensitive topic [1]. In contrast with others reporting and promoting quality assessment at unit level [2–4], the article highlights the surgeon's individual performance, expressed by the Surgeon Performance Index (SPI). In this respect, the article is progressive, presenting public data, good and bad, without distinction. The authors thus take up a vulnerable position, which takes courage.

However, despite the efforts and the good intention, the article contains several pitfalls. It is important to recognize these pitfalls, especially in the case of quality control. Otherwise, misuse of articles such as this will undermine the importance and power of quality assessment.

	1. Variables

 
The authors use early mortality, early rethoracotomy for bleeding, sternal rewiring for instability and mediastinitis as variables for their assessment and use the EuroSCORE for risk adjustment [5]. Firstly, why not use variables which have an accepted association with quality of care, as presented by several quality improvement organizations [2–4]? Secondly, the used variables differ from the definitions given in internationally used systems, thus making benchmarking impossible. Moreover, the used definitions are free to interpretation. Sternum instability is defined as visible movement of sternal edges, necessitating sternum . . . [Full Text of this Article]

This article has been cited by other articles:

				L. K. von Segesser Clinical databases - a double-edged sword! Eur. J. Cardiothorac. Surg., May 1, 2009; 35(5): 749 - 750. [Full Text] [PDF]