Measuring and managing quality of surgery. Statistical vs incidental approaches.

This study compares the costs and values of two approaches to generate quality improvement. The first, an incidental approach, uses a multidisciplinary conference format to discuss cases in which a postoperative complication occurred. The second, a statistical approach, systematically captures annual death and complication rates for comparison with previous years’ rates and national norms. While presenting tables of common surgical death and complication rates, the authors suggest that greater value exists from the incidental approach that supports necessary knowledge, safety, and effectiveness of surgeons. They conclude that both approaches should occur continuously, with the statistical approach used only to validate the effects of the incidental approach and respond to concerns of safety and quality.