Risk-adjusted surgical outcomes

Measures of risk-adjusted outcome are particularly suited for the assessmen t of the quality of surgical care. The reliability of measures of quality t hat use surgical outcomes is enhanced by prospective data acquisition and s hould be adjusted for the preoperative severity of illness. Such measures s hould be based only on reliable and validated data, and they should apply s tate-of-the-art analytical methods. The risk-adjusted postoperative mortali ty rate is useful as a quality measure only in specialties and operations e xpected to have a high rate of postoperative deaths. Risk-adjusted complica tions are more common but are limited as a comparative measure of quality b y a lack of uniform definitions and data collection mechanisms. In specialt ies in which the expected postoperative mortality is low, risk-adjusted fun ctional outcomes are promising measures for the assessment of the quality o f surgical care. Measures of cost and patient satisfaction should also be i ncorporated in systems designed to measure the quality and cost-effectivene ss of surgical care.