| Summary: | Publication of surgical activity and mortality was first introduced in the United Kingdom (UK) in 2004 for adult cardiac surgery. The Kennedy Inquiry into paediatric cardiac deaths at the Bristol Royal Infirmary [1] motivated this initiative. The Freedom of Information Act in 2005 and the Francis Report [2] which appeared in 2012 led to the NHS Commissioning Board’s document “Everybody Counts” [3]. Aimed to improve surgical care and promote patient safety, these reports underlined the need for greater transparency and informed patient decision-making. They recommended the publication of surgical “activity, clinical quality measures and survival rates from national audits for every practicing consultant” in nine surgical specialties and in interventional cardiology. Adjusted 90-day mortality rates are currently available online for all colorectal cancer surgeons in England [4], but the introduction of surgeon-specific outcome data (SSD) has raised concerns, not least because of the variable quality of such dataand the statistical methods employed to analyse them [5], but also over the value of these results for informing patient and clinician choice. While good evidence exists that surgeons support the publication of outcome data [6], there is a potential for this to influence a surgeon’s practice adversely, for example in avoiding elective surgery for high-risk patients. Alternative reporting methods may provide a more sensitive quality assessment of treatment by reflecting the multidisciplinary approach to perioperative care rather than that provided by the individual surgeon.
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