Modern medical practice should be based on evidence, but often in surgery we have little evidence for our surgical practice. Traditionally surgeons have relied on what they have been taught by their trainers or read in textbooks. The main source of information nowadays is the published literature but, in surgery, this is usually case series which is level 5 evidence. This raises several questions:
Are my patients comparable?
Do I have the skills to achieve these outcomes?
Has the surgeon included all the patients in the results?
The only results that you can rely on are your own. But human memory is selective and we tend to forget our poor results and remember the good ones. To reliably assess our own results requires audit. All surgeons should prospectively audit their own results. Using an established audit database is the most practical way to do this as others have already decided the most useful data to collect. Your data should be reviewed regularly, and results of your audit should be reported each year at your annual appraisal.
Auditing your own results allows you to compare your outcomes with those of other surgeons and tells you what is working and what needs improving.
