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Comment & Response
September 2016

No Surgeon Is an Island

Author Affiliations
  • 1Surgical Outcomes Research Centre, University College London, University College London Hospital, London, England
  • 2Health Services Research Centre, National Institute of Academic Anaesthesia, London, England
JAMA Surg. 2016;151(9):882-883. doi:10.1001/jamasurg.2016.0727

To the Editor The excellent Viewpoint by Jaffe and coauthors1 discusses the risks associated with inadequately considered surgeon-specific performance comparisons. This resonates with the views expressed when individualized outcome data were first made public for surgeons in the United Kingdom: the large sample sizes needed for comparison of quality when event rates are low makes such analyses relatively meaningless.2 A surgeon’s training and operative skill are, of course, integral to a good patient outcome, and Jaffe and coauthors1 cite previous work3 to support the view that video assessment of a surgeon’s operative skill may be an alternative and valid assessment tool. Indeed, quality of care may be influenced by any activity that makes the work of practitioners visible to others. However, we must seek the truth beyond these individualized surgical performance measures.

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