Two Hundred Years of Surgery
May 5, 2012 2 Comments
Dr. Atul Gawande’s latest article is available for free on NEJM.
In his usual analytical-turned-conversational manner, he reviews the evolution of surgery over the last two hundred years. He describes the roles that milestone advances such as anesthesia, antiseptics and technology played in making surgeries more successful and more common. In a telltale sign that he is at heart a huge measurement-geek, he even consistently measures these advances against the number of articles in the NEJM devoted to them over the years. Squeamish beware: there are some juicy/graphic descriptions of operations performed. Here’s an excerpt about the public health horizon and the opportunity to discover more surgical innovation by transforming the delivery system (emphasis added):
The increased safety and ease of surgery have produced an explosion in the volume of operations being performed — to at least 50 million annually in the United States alone. At the present rate, the average American can expect to undergo seven operations during his or her lifetime. This profound evolution has brought new societal concerns, including how to ensure the quality and appropriateness of the procedures performed, how to make certain that patients have access to needed surgical care nationally and internationally, and how to manage the immense costs. As early as the 1970s, researchers began documenting substantial rates of fatal errors in surgical care, wide differences in outcomes among institutions, and large disparities in access to care both within the United States and between countries. The science of effectively routinizing surgery for mass populations is still in its infancy, as it is for all areas of medicine. The Journal is entering its third century of publication, yet we are still unsure how to measure surgical care and its results. Experiments in the delivery of care will probably provide the next major advancement in the field of surgery.