Commentary: measures of early postoperative mortality

The traditional image of the paternalistic surgeon failing to offer patients an informed choice about treatment based on knowledge of the risks and benefits is disappearing rapidly. Driven by growing consumerism and political pressure, there is an increasing volume of information to help patients make choices that are appropriate for them. Examples range from patient information leaflets, through provision of specialist advisers, to interactive video disks.1 If patients are to be enabled to make truly informed choices the information that they receive must be accurate. Unfortunately, much of what is published about the risk of postoperative death may be misleading. Textbooks frequently quote case series published by those working in centres of excellence and relating to patients who may be quite atypical.2 Furthermore, published papers may be subject to considerable bias, ranging from the decision to report a series to acceptance by a journal.3 There are two major problems facing those who wish to measure population based postoperative death rates in the United Kingdom. The first is the absence of data on …