===== Traditional Audit =====

A **traditional audit** in surgical practice typically involves the periodic review of outcomes (e.g., monthly, quarterly, or annually) to assess complication rates, adherence to protocols, and performance metrics.

While valuable for long-term trend analysis, traditional audits have important limitations when it comes to detecting subtle or early changes in surgical performance.

==== Key Characteristics ====

  * **Aggregated data** over time (e.g., number of complications per month)
  * **Delayed feedback**—results are often available only after the audit cycle ends
  * **Less responsive** to short-term variability
  * Often focuses on **statistical significance** rather than **clinical relevance**
  * Usually conducted by quality assurance or governance teams

==== Common Uses ====

  * Institutional benchmarking
  * Departmental morbidity and mortality (M&M) reports
  * Accreditation and certification
  * Guideline compliance review

==== Limitations ====

| Limitation                         | Impact                                          |
|------------------------------------|-------------------------------------------------|
| Delayed detection                  | Complications may accumulate unnoticed          |
| Insensitivity to small changes     | Subtle learning curves or decline go undetected |
| No real-time correction            | No immediate feedback for the operator          |
| Aggregated averages mask outliers  | Individual trends may be hidden                 |

==== Why CUSUM Offers an Advantage ====

CUSUM provides a **case-by-case dynamic view**, making it far more sensitive and actionable in scenarios where **early detection** and **individualized monitoring** are essential—such as surgical training, new procedures, or patient safety monitoring.

While traditional audits remain useful for **macro-level assessments**, CUSUM fills the gap at the **micro-level**, offering real-time insights and the ability to intervene before trends become problems.

==== Best Practice ====

A robust surgical quality system should combine:
  * **Traditional audits** for global, institutional performance
  * **CUSUM analysis** for real-time, individual-level monitoring and early warning