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Defining surgical success
  1. Bruce Jaffray
  1. Correspondence to Bruce Jaffray, Department of Paediatric Surgery, The Great North Children's Hospital, Newcastle upon Tyne NE1 4LP, UK; bruce.jaffray{at}nhs.net

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Although Benjamin Franklin opined that death and taxation are the only certainties in this life, for most of us, the need to undergo a surgical procedure at some point is also inevitable. Society consequently has a vested interest in the outcomes of surgery being successful. Through recorded history, just surviving an operative intervention was regarded as near miraculous. Aseptic technique, anaesthesia and understanding of resuscitation made surgery safe, at least for first world populations, but the objective analysis of what surgeons do and the outcome of their activity is a relative novelty in historical terms. While the universal acceptance of Archie Cochrane’s insistence on randomised trials as proof of efficacy has ended many worthless interventions, we are still left with difficult questions when we think about surgery and what defines success and how we measure it.

For some conditions, the definition of success would seem self-evident. Five-year disease-free survival for most solid malignancies is conventionally regarded as cure. But inherent biological variation means that some patients are cured, while others with apparently the same tumour load die. Population screening allows some diseases to be diagnosed at earlier stage with better prognosis, but otherwise, we can do little to modify the disease burden the patient presents with. Patient-related variables such as obesity, neurological status or diabetes will explain some variation, but there remain differences in outcomes which can only be attributed to the efficacy of healthcare delivery, often a surgical intervention.

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Footnotes

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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