Balancing benifits and burdens in surgery

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Abstract
Evaluation of the benefits and burdens of surgery has become increasingly important, given the expectations of society and the climate of economic restraint. Criteria must be defined precisely if outcome is to be assessed, and patient preference is now a major factor in surgical decision making. Variations in the quality of surgical practice is an increasing concern and the need for continuing audit is paramount. If resources have to be rationed, surgeons must pay increasing attention to the benefits gained by different medical and surgical interventions in given diseases. The quality-adjusted life year (QALY) is a useful unit of measurement in assessing these benefits. A plea is made for the development of agreed guidelines on which to base surgical practice.

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