[Difficult to measure results and quality of surgical interventions but length of stay is an important variable]

No generally accepted measures exist to describe the quality of surgical care. Measures derived from surgical care processes are relatively easy to improve but are often too local to allow comparison with other surgical departments. The final outcome of an operation is often difficult to record objectively or can only be determined after observation. Improving items of the process is often insufficient to markedly improve outcome because process and outcome are logarithmically related. Therefore, a department's surgical balance sheet remains stable over several years. The introduction of new techniques or new concepts of treatment with sufficient potential for change can improve that balance sheet if effectively implemented. Quality of care implies a rating of the outcome relative to a standard or in comparison with the achievement of other surgical departments. It is argued that postoperative hospital stay is an objective, verifiable, and uniformly recorded outcome measure that reflects the combined achievement of the surgical, organisational, and social processes for each patient. Laparoscopic cholecystectomy, a new technique, tension-free inguinal hernia repair, and fast-track surgery, a new concept, all had the potential to shorten the hospital stay. The mode of change seems to be diminished surgical and anaesthetic trauma and therefore fewer complications. The ultimate quality achievement is to be able to operate without causing physiological derangement of the patient, which should eventually allow day-surgery for most elective procedures.