Comparative audit: an experimental study of 147,882 general surgical admissions during 1990.

In 1991, 1025 general surgical Fellows of The Royal College of Surgeons of England were circulated with a pro forma and asked to submit local audit results for admissions during 1990 to a confidential comparative audit service. The individual topics of cholecystectomy and colorectal resection were studied. Data returned by 160 surgeons concerned 147,882 admissions including 122,620 operations. Overall mortality rates ranged from 0 to 5 per cent and morbidity rates from 0 to 22 per cent. Laparoscopic cholecystectomy was associated with one-quarter of the mortality rate and two-thirds the morbidity rate of open cholecystectomy. Of the 33 surgeons who responded to a survey after the presentation of results, all wished to continue the exercise in future years; 39 per cent had been stimulated to perform further analyses and 15 per cent had changed practice habits as a result. Comparative audit involving large numbers of patients and surgeons is feasible and seems beneficial to participants.