Requires innovative methods for getting evidence into surgical practice

Variations in surgical care have been recognised since the early 1980s and are generally interpreted as evidence of uncertainty among practitioners regarding optimal care. The prescription for remedying variations in surgical practice has generally included development of better medical evidence to identify best practices, dissemination of medical evidence to surgeons, and use of practice guidelines and care pathways to streamline care. More than 20 years later, there is still abundant evidence that surgical care varies substantially. Why do variations in surgical care persist? And what can be done about them?

In this issue of BMJ, Lassen et al (p 1420) report the results of a survey of lead surgeons in five north European countries regarding processes of care for colorectal surgery.1 These processes included use of preoperative bowel preparation, routine postoperative nasogastric decompression, and use of epidural analgesia in the …