Measuring the quality of surgery: should textbook outcomes be an off-the-shelf or a bespoke metric?
Measuring the quality of healthcare has become increasingly important, with surgery not exempt from such evaluation. As technological opportunities and novel developments broaden the range and complexity of treatments that can be offered, the strain on resources is increasing in most healthcare systems worldwide. This is particularly the case for universal healthcare systems, where the budget is based on an allowance and care is given on a needs-based assumption. Thus, the quest of measuring what is done and how well is driven from several stakeholders’ perspectives—including governmental monitoring, hospital administrations, clinical specialty organisations and the care givers. However, exactly how healthcare quality should be assessed remains a difficult task. A particular challenge is the quest for defining surgical quality metrics. Some outcome metrics used in the past, such as in-hospital mortality or length of hospital stay after surgery, may not reflect the quality of care per se, especially when...