Measuring the quality of surgical care: structure, process, or outcomes?1

Key Points

• To evaluate the strengths, limitations, and practical applications of structural, process-based, and outcome-oriented metrics in assessing the quality of surgical care.
• Reviewed quality assessment frameworks based on the Donabedian model within surgical specialties.
• Evaluated performance indicators including hospital procedural volume, clinical care process adherence, and risk-adjusted mortality and complication rates.
• Structural characteristics, such as hospital procedural volume, serve as practical quality proxies but do not directly assess individual surgical proficiency.
• Process measures evaluate adherence to evidence-based clinical guidelines but require verified links to meaningful clinical endpoints.
• Outcome measures represent the definitive assessment of care quality but require adequate sample sizes and rigorous risk adjustment to account for patient case mix.