Measuring quality in colorectal surgery

Over the past 10 years, the spotlight on quality in medical and especially surgical care has intensified for several important reasons. High profile reports have publicised vast numbers of (presumably) avoidable adverse outcomes1; clinically unexplained variations in use and outcomes of care persist2 3; and sophisticated software and hardware permit population based tracking of multiple quality measures.4 Accordingly, researchers and policy makers have prioritised the identification of relevant and actionable measures of quality.

Primary medical care tends to be longitudinal, so quality is often tracked by processes of care, such as delivery of treatment or cancer screening—with little pragmatic knowledge of the ultimate outcomes. In contrast, surgical care is cross sectional, so it is therefore cheap and feasible to measure surgical outcomes. Whereas the outcomes measured in medical care are often positive (for example, reduction in glycated haemoglobin, survival), the clinical outcomes measured most commonly in surgical care are negative (for example, 30 day mortality and perioperative morbidity).

One such adverse outcome, unplanned return to the operating room after colorectal surgery, is assessed in the linked retrospective study by Burns and colleagues (doi:10.1136/bmj.d4836).5 Unplanned reoperation is an appealing target …