Application of variable life adjusted display (VLAD) to risk-adjusted mortality of esophagogastric cancer surgery

R. V. Guest*, V. V. Chandrabalan, G. D. Murray, C. D. Auld

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose In the new era of revalidation, there is an increasing need to measure surgical outcome objectively. We apply a graphical method, the Variable Life Adjusted Display (VLAD), to esophagogastric resection for malignancy. This technique charts the cumulative difference between expected and actual risk-adjusted mortality over time, allowing observation of performance trends irrespective of case-mix. Methods P-POSSUM was applied retrospectively to 182 consecutive patients who underwent resection for esophageal or gastric malignancy in a district general hospital. The primary outcome measured was 30-day mortality. Results A total of 168 patients were eligible for inclusion, with a median age of 68 years. The overall 30-day mortality rate was 4.2% compared with 7.1% as predicted by P-POSSUM. The resulting VLAD plot demonstrates an upward trend of better than predicted surgical performance. Conclusions VLAD has been hereby applied to esophagogastric surgery and has graphically demonstrated riskadjusted trends in a single general surgeon's performance. For qualitative comparative purposes, including recertification, VLAD is judged to be a simple, directly interpretable, and useful technique for monitoring surgical performance. © Société Internationale de Chirurgie 2011.

Original languageEnglish
Pages (from-to)104-108
Number of pages5
JournalWorld Journal of Surgery
Issue number1
Publication statusPublished - 1 Jan 2012


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    Murray, G.



    Project: Research

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