Measuring Surgical Outcomes : Need of the Hour

Managed health care is taking roots all over the world. Surgical care is now regarded as a commodity which is being increasingly bought by insurance companies for populations. Health plans and payors have begun to focus on the quality of care provided. In an effort to improve patient safety and reduce costs detailed studies by medicare and medicaid services focusing on mortality and morbidity rates are regular features of journals. Surgeons are under increasing pressure to demonstrate patient safety data which meet or even exceed benchmark standards. Surgeons will always be the first to be scrutinized simply because it is much easier to identify mishaps associated with surgery. Records are more detailed and forms are more likely to be filled if it is an operative record. The buyers of health care are getting increasingly aware that variability exists in surgical care quality. Administrators, health care researchers, insurance companies and indeed health professionals are all agreed that our current health care systems are not optimum. They need to be revolutionized. Undoubtedly the safety of our patients must be the pivot of all our endeavours.1 The Colorado/Utah study,2 Harvard Medical practice study3 and the Institute of Medicine report4 all document a very high incidence of adverse events in hospitals. Past studies focused on abstracting of charts by personnel remote from the site and after the care was delivered. Ideas are being examined to evaluate the impact of reporting by deputed personnel at the time the service is being delivered. The key questions that need to be answered are: ? How to measure outcomes in surgery? ? Who should do the measuring ? 1. Patients. 2. Buyers of health care. 3. The surgical community itself. MEASURING SURGICAL OUTCOMES : NEED OF THE HOUR REVIEW ARTICLE J Nep Med Assoc 2004; 43: 333-336