Valid peer review for surgeons working in small hospitals

Background: Hospitals with one or only a few practicing surgeons need a valid way to analyze the quality of their work. Head-to-head comparisons, especially in a competitive small environment, are not likely to be fruitful. Methods: We compared the quality of surgical care delivered by a single surgeon whose practice was located in rural Kentucky with that of a group of peers in the same region. A surgical data sheet was completed by each of the participating surgeons from July 1, 1998, to September 1, 2001. The cases were entered into a database maintained by a professional limited liability corporation, which was founded to enhance the quality of surgical care. We measured quality of care based on complication rate, patient education, resource utilization, use of diagnostic testing, and number of days the patient returned to work. Results: A total of 11,761 cases were entered into the database during the 38 months recorded. Of those, 256 cases were performed by the studied surgeon. The cases included skin and subcutaneous biopsies (n = 145), colonoscopies (n = 80), upper endoscopies (n = 25), and inguinal hernia repair (n = 6). The studied surgeon performed better than the peer group in the categories of patient education, complication rates, and use of diagnostics. Resource utilization, as measured by length of stay, was identified as an area that could be improved. Conclusions: By using this organization and its methods, a good way to identify strengths and weaknesses of delivered surgical care is enabled.