Intended for healthcare professionals


Improving patient outcomes after surgery

BMJ 2017; 359 doi: (Published 10 October 2017) Cite this as: BMJ 2017;359:j4580
  1. Clare Marx, immediate past president,
  2. Derek Alderson, president
  1. The Royal College of Surgeons of England, 35-43 Lincoln’s Inn Fields, London WC2A 3PE
  1. cmarx{at}

The sex of the surgeon is unlikely to be relevant

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 …

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