Evolution of Outcomes in Cardiothoracic Surgery

The measurement of outcomes is a fundamental component of modern surgery to provide the foundations of surgical improvement. The conventional emphasis of clinical outcomes such as morbidity and mortality has been augmented with a growing focus on quality of life, quality of care and patient satisfaction. Outcome measures can provide cardiothoracic surgeons the opportunity to assess their results in increased precision and transparency. An initiative to increase patient awareness and education regarding their hospitals and their surgeons has meant a necessary move towards greater clarity and accountability of all surgical centres. This has seen an adaptation towards a more patient-centered approach. Comprehensive quality measures and a framework for analyzing and interpreting these results is pivotal as is knowing what to measure and how to measure it. Innovative approaches whereby the patient measures and reports their own ‘outcome’ and experience are being piloted in all surgical specialties, including cardiothoracic surgery. Adopting the Donabedian model for quality measurement in three domains structure, process, and outcomes is a valid and reliable instrument for assessing patient’s satisfaction and quality of care as are the wide range of validated surveys of health related quality of life, which should be routinely implemented. BACKGROUND The measurement of outcomes is a fundamental component of modern surgery to provide the foundations of surgical improvement. Whilst the emphasis and importance on these measurements has not changed, both the nature of the outcomes measured and the methods for doing so have evolved. The conventional emphasis of clinical outcomes such as morbidity and mortality has been augmented with a growing focus on quality of life, quality of care and patient satisfaction. These empower patients to report their own outcomes subjectively. We examine a number of these outcome measures and their importance for increasing patient centeredness, and an inclusive approach to cardiothoracic surgery.