Surgical outcomes research: a progression from performance audits, to assessment of administrative databases, to prospective risk-adjusted analysis – how far have we come?

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Abstract
This review focuses on how the assessment of surgical quality and safety has evolved from individual performance audits and morbidity and mortality reviews, to assessment of large administrative databases, to the current practice of prospective risk-adjusted analysis by a National Surgical Quality Improvement Program for children's surgical care. This evolution follows the natural availability of surgical outcome data and a national call for improved hospital care safety and quality. Two new advances in children's surgical care include the comparative use of national health record data compiled in administrative datasets and the use of a risk-adjusted assessment of children's surgical morbidity and mortality as assessed by a newly developed National Surgical Quality Improvement Program for children's operative care. The value and application of these two datasets are presented. The evolution of the assessment of surgical quality and safety will equip the surgeon with an optimal array of outcome assessment tools to assure the best in surgical quality and safety for the pediatric patient.