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