title: [Acceptable risks in surgery from the perspective of the evidence-based medicine and an evaluation of the quality of surgical care].
abstract: A qualified assessment of the risks of surgical treatment and especially operations is based on the evaluation of morbidity, mortality and long-term results of surgeons work. These analyses should be conducted based on the principles of the evidence-based medicine (EBM) and, in recent years, an assessment of the risks that surgical treatment has been included into a broader complex of evaluating the quality of surgical care. Surgery, other surgical specializations, and the urgent medicine belong among medical fields which most often carry a risk of unsuccessful outcomes and complications. Taking into account the complexity of medicine, the diagnostic and therapeutic processes are burdened necessarily by a certain number of complications. It is never possible to completely eliminate human errors, but what is possible is to continuously decrease their numbers and repair them on time. EBM is defined as a method of treating for patients based on the best scientific evidence resulting from clinical and epidemiological scientific research publications. From an EBM perspective, surgery compared with pharmaceutical treatment is usually at a disadvantage because the studies with the highest level of evidence (the controlled randomized studies) are usually not possible to be performed in surgery. In various situations it is only possible to obtain certain kinds of evidence and in surgery the highest level of evidence is most often obtained from cohort studies and case control studies as a possible means of sorting our information. Currently, evaluating the quality of surgical care should be in the forefront of interest of every surgeon. Traditional criteria include the evaluation of operative and postoperative complications, mortality, the number of re-operations, the evaluation of the satisfaction of the patient with the procedure performed, the length of survival of oncological patients, the number of recurrences and a number of other criteria. The term "High Volume Hospital" represents a newly developing concept of evaluating quality in surgery, which arises from the assumption that with the increasing number of procedures (operations) performed the quality of the results attained increases as well. The evaluation of quality in surgery is a topic which should be addressed more thoroughly among surgeons. The creation of indicators of quality of surgical care and their application into clinical practice has great significance for the development of surgery and it is not possible to leave it beyond the control of surgeons.
authors.forename: M
authors.initials: M
authors.lastname: Duda
authors.forename: L
authors.initials: L
authors.lastname: Adamčík
authors.forename: M
authors.initials: M
authors.lastname: Škrovina
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D009017:Morbidity; D011183:Postoperative Complications; D011785:Quality Assurance, Health Care; D013514:Surgical Procedures, Operative / Q000009:adverse effects*