Improving patient outcomes after surgery

Factors associated with variation in outcome after surgery have been a topic of major interest for the past 20 years. By far the most explored is the relation between case volume and outcome. Hospital and surgeon volumes have been examined in most surgical specialties and related to many short and long term outcomes.123 Certainly for more complex procedures, higher institutional volumes correlate with better outcomes. The evidence for individual surgeons is less clear, often reflecting the outcome. Low volume cardiac surgeons, for example, have only slightly higher rates of complications but far higher rates of death in hospital than high volume surgeons.4

Virtually all studies that examine factors related to surgical outcome are observational. Causal relations are difficult to prove. As a result, programmes …