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Viewpoint
November 2017

Intraoperative Surgical Performance Measurement and Outcomes: Choose Your Tools Carefully

Author Affiliations
  • 1Department of Surgery, McGill University, Montreal, Québec, Canada
  • 2Steinberg Centre for Simulation and Interactive Learning, McGill University, Montreal, Québec, Canada
JAMA Surg. 2017;152(11):995-996. doi:10.1001/jamasurg.2017.0837

Surgical outcomes exhibit variability, with convincing evidence that higher surgeon and hospital volumes, more so for complex procedures, lead to lower rates of morbidity and mortality.1 Quality metrics at the surgeon level may be based on structural factors such as case volume, processes like operative time and blood transfusion rates, or outcomes defined by morbidity, mortality, or quality of life scores. All measures have their advantages and disadvantages, which may depend on the procedure, setting, and ultimate goal of quality measurement. Volume is a proxy for expertise at the surgeon, clinical team, and hospital levels. Researchers have attempted to define underlying constructs for these relationships, such as the measurement of surgical skill in the operating room,2 variation in failure to rescue rates following surgery,3 and definition of system factors such as high nurse ratios and the presence of complex imaging facilities.4 This Viewpoint considers tools for measuring intraoperative performance with relation to surgical outcomes.

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