title: Debate: should we use variable adjusted life displays (VLAD) to identify variations in performance in general surgery?
abstract: BACKGROUND
  The recent push for the publication of individual surgeon outcomes underpins public interest in safer surgery. Conventional, retrospective assessment of surgical performance without continuous monitoring may lead to delays in identifying poor performance or recognition of practices that lead to be better than expected performance.
  
  
  CONCLUSIONS
  The variable life adjusted display (VLAD) is not new, yet is not widely utilised in General Surgery. Its construction is simple and if caveats are appreciated the interpretation is straightforward, allowing for continuous surveillance of surgical performance.
  
  
  CONCLUSIONS
  While limitations in the detection of variations in performance are appreciated, the VLAD could represent a more useful tool for monitoring performance.
authors: Department of Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK.
authors: Stephen
authors: S
authors: O Neill
authors: Department of Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK.
authors: Stephen J
authors: SJ
authors: Wigmore
authors: Department of Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK. mail@ewenharrison.com.
authors: Ewen M
authors: EM
authors: Harrison
mesh_terms: D002983:Clinical Competence; D013502:General Surgery / Q000592:standards; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D015996:Survival Rate