Monitoring surgical outcomes: How and why?

Abstract

Reliable and valid measures of risk and outcome are essential prerequisites for the effective monitoring of outcome following surgery and the evaluation of innovations in perioperative care. Enhanced Recovery (ER) programs raise the exciting prospect of reduced resource utilisation in combination with improved (or at least equivalent) outcomes. Careful monitoring of process (compliance with ER elements) and outcome are essential if this goal is to be achieved without unintended harm to patients (e.g. increased readmission due to postoperative morbidity arising in the community).

Risk (case-mix) adjustment is necessary to separate the influence of patient and care factors and thereby minimise the effects of case-mix variation on evaluation of care quality. Outcome measures that are useful when evaluating ER programs include: length of hospital stay, readmission rate, total hospital stay, morbidity/complications, patient reported outcome measures and death. Description of postoperative morbidity should use validated measures, rather than ad hoc lists of medical diagnoses.