The history of surgical audit

The history of surgical audit is outlined with particular reference to its development in Australia. Surgical audit fundamentally consists of assessment of results by counting and some form of publication for peer review. In its basic form it has been practised by the great surgeons since the last century, but its universal acceptance and practice is very recent. Early attempts at formal audit of surgical results within American hospitals began early this century, but they were described as 'polite, restrained discussion'. Following the development of quality assurance in industry, similar serious methods of assessment of outcome were adopted by the medical profession. In Australia, surgical audit was pioneered by Smyth in the 1950s, and his papers remain goal standards of audit methods. Though not initially welcomed by the profession, surgical audit is now essential for hospital accreditation and registrar training. There are many varieties of audit but all require critical assessment of surgical outcome.