CUSUM Analysis for Morbidity and Mortality Meeting in Neurosurgery

Morbidity and Mortality meetings are essential for improving patient safety, surgical education, and quality of care. Traditionally based on retrospective case discussion, they can be enhanced by incorporating CUSUM (Cumulative Sum) analysis to provide real-time, data-driven insights into performance trends.

• Offers a quantitative framework to complement qualitative discussion
• Detects early deviations from expected complication rates
• Tracks individual or team learning curves
• Provides objective support for supervision decisions, case allocation, or protocol updates

• Outcome-based tracking (e.g., surgical site infection, hemorrhage, misplacement of devices)
• Case-by-case visualization of performance trends
• Visual alert thresholds to identify when complication rates exceed acceptable limits
• Ability to stratify data by surgeon, resident, technique, or complexity level

1. Pre-meeting preparation:

1. Generate CUSUM charts for relevant procedures (e.g., ICP monitor placement, craniotomy, spinal fusion)
2. Highlight curves crossing predefined alert thresholds (e.g., 2.5)

2. During the M&M meeting:

1. Present CUSUM curves alongside traditional case narratives
2. Use the curves to identify whether a complication is part of a random variation or part of a trend
3. Discuss potential causes: learning curve phase, supervision level, protocol adherence, etc.

3. Post-meeting actions:

1. Recommend supervision changes, simulation training, or protocol updates if needed
2. Reassess the operator's CUSUM at the next M&M session

*Case*: A resident presents with 3 complications in 15 ICP monitor placements. *CUSUM chart*: Rising trend, crossing alert threshold at case #14. *Interpretation*: Trend suggests performance deterioration, not just isolated incidents. *Action*: Reinforce direct supervision and review technique; follow-up at next M&M.

• Early detection of performance issues
• Fair and structured evaluation of trainees and techniques
• Reinforces a safety culture based on transparency and improvement
• Aligns with accreditation standards and clinical governance expectations

Integrating CUSUM into M&M meetings transforms them from anecdotal reviews into structured, outcome-driven improvement platforms.