Adaptive Risk‐Adjusted Weighted CUSUM Chart for Monitoring Surgical Performance

ABSTRACT Detecting changes in surgical performance early is important to improve the quality of surgery. In recent years, numerous risk‐adjusted control charts have been applied to monitor surgical performance. The conventional risk‐adjusted cumulative sum (CUSUM) charts need to be preset with the out‐of‐control odds ratio, and the performance of the control charts can be significantly affected by the actual change level. To effectively monitor changes in surgical performance, this paper proposes a novel adaptive risk‐adjusted weighted cumulative sum (RA‐WCUSUM) chart for monitoring binary surgical outcomes, where a weighting function based on standardized residuals is applied to the log‐likelihood ratio statistic. The proposed method is compared with several competing charts through simulation, and the simulation results show the superiority of the proposed method. A cardiac surgery dataset is used to demonstrate the application of the proposed method.