Vancouver researchers are set to explore the effectiveness of 6 common elective operations from a patient's perspective. The Regional Evaluation of Surgical Indications and Outcomes is the "first attempt at an outcomes-management program for surgical services in Canada," says Dr. Charles Wright, a surgeon who directs the Vancouver Hospital's Centre of Clinical Epidemiology and Evaluation. "We spend a lot of time measuring deaths and survival and intermediate outcomes, but [these studies] don't speak to the final outcome for the patient, to health-related quality of life. We have never done that before."
Wright says that well-known regional variations for procedures such as cataract removal suggest that decision-making is often judgemental. "All of these elective procedures are not designed to prolong survival but to make you feel better," says Wright, who devised the project and obtained Health Canada funding. "So why not measure the quality of life?"
More than 10 000 patients are being recruited from Vancouver-area hospitals, and every surgeon performing cataract removals, total hip replacements, cholesystectomies, prostatectomies, hysterectomies and spinal disc surgery is participating. When patients are booked for surgery they receive a quality-of-life questionnaire, which they also complete at intervals following surgery. Surgeons will provide their indications for recommending surgery prior to performing the operations.
Wright says some surgeons resent being second-guessed, but many recognize that this is an idea whose time has come. "People expect [surgeons] to demonstrate results."