Quality measurement of outcome in general surgery revisited: commentary and proposal

Surgery has been trying to catch up to evidence-based medicine. Assessment of outcome in surgery is the child for quality assurance of patient care. We surgeons have our own set of mental variables that can predict good and poor outcomes. We value our experience and that of others, yet, are always inquisitive about which best predict morbidity and mortality. We all have our own functional equations for outcome that varies qualitatively and quantitatively. The main problem is lack of a uniform mathematical equation for individual patient risk factors that we refer to because of the limitations inherent in the equation or our understanding and awareness. Reviewing the literature in surgical outcome measurement, the impression is one of increasingly diverse messages with conclusions that are institution dependent. This can initiate confusion and controversy when comparing outcomes or extrapolating to one's own practice while hindering training surgeons to contribute to the evolving evidence of objective quality measurement early in a career. Overall, we are falling behind in recognizing this evolving problem. In this article, I address this controversy and attempt to offer new avenues in achieving a consensus among us in patient risk-adjusted outcomes by adopting and modifying well-recognized risk scoring systems from either side of the Atlantic Ocean. The millennium should see the birth of a new generation of surgeons charged with evidence-based ideas in quality outcome measurement and ready to improve current mathematical models.