Intraoperative Consultation as an Instrument of Quality Management

Excerpt

It is not easy to collect data and analyze intraoperative decision making, the subtleties anesthesia, and technical surgical endeavors. As a result, the operation has historically been a “black box” in the field of surgical health services research. Preoperative risk factors and postoperative occurrences are described in extensive detail, but operative decision making is rarely studied. Within this context, in this issue of the World Journal of Surgery, Petersen et al. report a unique approach to surgical quality improvement focusing completely upon the operation [1]. In short, an attending surgeon provided an intraoperative consultation for every operation over a 6-month period. Routine intraoperative consultation did not frequently affect intraoperative clinical decision making. Conversely, when a “tactical” intraoperative consultation was initiated, intraoperative decision making changed over 50% of the time. Overall, it seems that having a second surgeon in difficult cases significantly changes the operation. …