The report by the Lancet Commission on Global Surgery recently highlighted 6 core measurable indicators essential to achieving the goal of universal access to safe, affordable surgical and anesthesia care.1 One indicator, perioperative mortality, was identified as crucial for monitoring progress toward this goal. However, adverse events, including postoperative mortality, are an inevitable consequence of major surgery and some adverse events may be expected or even acceptable. Without case-mix adjustment and taking the heterogeneity of surgical patients and procedures into account, hospitals that manage sicker patients would appear to have worse outcomes. Reporting perioperative mortality alone offers little in the way of meaningful comparisons or identifying opportunities for quality improvement.
Spence RT, Mueller JL, Chang DC. A Novel Approach to Global Benchmarking of Risk-Adjusted Surgical OutcomesBeyond Perioperative Mortality Rate. JAMA Surg. 2016;151(6):501–502. doi:10.1001/jamasurg.2016.0091