Reporting orthopaedic surgeons' outcomes: 100 years after Codman

UK surgeons often spend their working lives repeatedly performing a series of operations routine to them. Few data are collected on the outcomes of surgeons’ routine work. Any information given to patients about the success of a planned procedure will likely be derived from the literature. Mandatory collection of surgeons’ data is currently limited to specialist registers concerning arthroplasty and other complex surgery. The Paterson inquiry report, published in 2020, fell short of suggesting a comprehensive collection of outcomes data but recommended publication of a list of operations commonly performed by a surgeon. The idea of comprehensive data collection is not new. In 1905, an American shoulder surgeon, Ernest Codman, suggested the ‘end result’ idea, which involved publishing data regarding the outcome of every operation performed. Codman’s scheme (and his career) failed. This paper looks at the reasons for the failure of Codman’s idea and surveys the current schemes of surgical outcomes data collection. For future successful data collection, the interested parties need to agree why data should be collected, how the system will be paid for, what data will be collected, how data quality and interfering variables will be managed, and how the data will be analysed and presented to interested groups. With many barriers to data collection still present, what lies ahead for quality assessment?