How to improve surgical outcomes

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39545.504792.80 (Published 24 April 2008) Cite this as: BMJ 2008;336:900
  1. Peter J E Holt, clinical lecturer in vascular surgery1,
  2. Jan D Poloniecki, reader in medical statistics2,
  3. Matt M Thompson, professor in vascular surgery1
  1. 1St George’s Vascular Institute, London SW17 0QT
  2. 2Community Health Sciences, St George’s, University of London, London SW17 0RE
  1. peteholt{at}btinternet.com

    Data should be monitored and acted on at local and national levels

    Surgical outcomes are increasingly being scrutinised through national audit and publication of unadjusted league tables.1 Two accompanying studies report different ways of measuring surgical outcomes and performance—one in groin hernia repair and the other in percutaneous coronary intervention.2 3 Public scrutiny of surgical outcomes should be encouraged, but the data and statistical analysis should be robust, meaningful, and accurate. Unadjusted league tables are often misleading because they take insufficient account of the patients’ risk factors. Commercial organisations can also produce in-depth analyses of NHS data, but many clinicians argue that the accuracy of the raw data is questionable and that such analyses are expensive and of unknown utility.

    Encouraging clinicians to take responsibility for data analysis at local and national levels could improve our understanding of surgical results and help develop ways to improve outcomes. The outcomes studied should be important and easy to measure—for example, postoperative death or disease specific recurrence rates. Studies on “benefit” need further development before risk-benefit analyses can be used …

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