title: Risk-adjusted surgical outcomes.
abstract: Measures of risk-adjusted outcome are particularly suited for the assessment of the quality of surgical care. The reliability of measures of quality that use surgical outcomes is enhanced by prospective data acquisition and should be adjusted for the preoperative severity of illness. Such measures should be based only on reliable and validated data, and they should apply state-of-the-art analytical methods. The risk-adjusted postoperative mortality rate is useful as a quality measure only in specialties and operations expected to have a high rate of postoperative deaths. Risk-adjusted complications are more common but are limited as a comparative measure of quality by a lack of uniform definitions and data collection mechanisms. In specialties in which the expected postoperative mortality is low, risk-adjusted functional outcomes are promising measures for the assessment of the quality of surgical care. Measures of cost and patient satisfaction should also be incorporated in systems designed to measure the quality and cost-effectiveness of surgical care.
authors.affiliation: Department of Medicine, Boston Veterans Administration Healthcare System, Harvard Medical School, Boston, Massachusetts 02114, USA. jdaley1@partners.org
authors.forename: J
authors.initials: J
authors.lastname: Daley
authors.forename: W G
authors.initials: WG
authors.lastname: Henderson
authors.forename: S F
authors.initials: SF
authors.lastname: Khuri
mesh_terms: D000203:Activities of Daily Living; D003362:Cost-Benefit Analysis; D003625:Data Collection / Q000379:methods; D003627:Data Interpretation, Statistical; D017052:Hospital Mortality; D006787:Hospitals, Veterans; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D009017:Morbidity; D017060:Patient Satisfaction; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D015203:Reproducibility of Results; D020379:Risk Adjustment / Q000379:methods*; D012720:Severity of Illness Index; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000523:psychology / Q000592:standards*; D016019:Survival Analysis; D017749:Total Quality Management / Q000458:organization & administration; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs