Fostering a Culture to Support Surgical Outcome Measures.

For decades, it is known that surgical outcomes vary by surgeon. Numerous studies have shown that surgeons (and hospitals) with higher volumes have better outcomes. More recently, Birkmeyer et al demonstrated that surgical skills (referring to the gentleness, tissue exposure, instrument handling, time and motion, and flow of operation) are associated with outcomes and that a surgeon’s skills are related to their case volume. Surgeons are an important part of the quality equation, and measures of their outcomes are important for patients when deciding about whether to proceed with a given procedure, in a certain hospital, with a specific surgeon. Consider, for example, the case of a healthy 65-year-old, asymptomatic woman who on routine physical examination is found to have severe mitral regurgitation. The guidelines recommend early surgical repair provided that the likelihood of achieving durable valve function is >95%, which is possible when performed by an experienced surgeon in a center of excellence. Reasonably, patients and referring clinicians should have access to well-designed, rigorous outcome measures that enable comparison of performance across surgeons and healthcare systems.