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A Novel Approach to Global Benchmarking of Risk-Adjusted Surgical Outcomes Beyond Perioperative Mortality Rate

Richard T. Spence, MBChB, MPH1,2; Jessica L. Mueller, BA2,3; David C. Chang, MBA, MPH, PhD2,3
[+] Author Affiliations
1Department of Surgery, University of Cape Town, Cape Town, South Africa
2Codman Center for Clinical Effectiveness in Surgery, Department of General Surgery, Massachusetts General Hospital, Boston
3Harvard Medical School, Boston, Massachusetts
JAMA Surg. 2016;151(6):501-502. doi:10.1001/jamasurg.2016.0091.
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This Viewpoint describes a novel approach to measuring quality in risk-adjusted surgical outcomes for hospital-, regional-, and global-level benchmarking.

The report by the Lancet Commission on Global Surgery recently highlighted 6 core measurable indicators essential to achieving the goal of universal access to safe, affordable surgical and anesthesia care.1 One indicator, perioperative mortality, was identified as crucial for monitoring progress toward this goal. However, adverse events, including postoperative mortality, are an inevitable consequence of major surgery and some adverse events may be expected or even acceptable. Without case-mix adjustment and taking the heterogeneity of surgical patients and procedures into account, hospitals that manage sicker patients would appear to have worse outcomes. Reporting perioperative mortality alone offers little in the way of meaningful comparisons or identifying opportunities for quality improvement.

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