Surgery Blog for Surgeons

Along the way we shall catch excellence...

Aiming at excellence is the natural goal for a lot of activities in people's lives. Our work is just one, granted a very important, aspect of this process.

Dr. Aloia from the MD Anderson Center in Houston just achieved a point on excellence by publishing a paper about striving for "Zero Harm".

One may not thing of this goal as being a problem but he outlines several issues along his path of improving his outcomes after liver resections. Going for a "Zero" complication rate leads to:

  • Perfection limits patient access.

    The need for having a "Zero" at the end of the day makes us rethink offering access to surgical help for higher risk patients.

  • Perfection and radical innovation are not compatible.

    Innovative approaches require a learning curve. Along that way, the complication rates are higher and procedures may be totally abandoned not because they don't offer an advantage in outcome but because they may bring along a higher number of complications.

  • Perfection and training are not compatible.

    If you train young surgeons, you need to increase their level of autonomy. Whenever you measure the outcomes of a procedure performed by a trainee, even when supervised by an experienced surgeon, and an expert, you will inevitably have a higher complication rate in the educational environment.

  • "The ultimate cost of aiming at Zero when Zero cannot be obtained is surgeon burnout."

    Frustration with not achieving the goal is a significant issue with today's surgeons.

So, where do we go from here?
Aiming at excellence is the only humanly achievable excellence, according to Dr. Aloia.
And this is a profoundly true conclusion which is relevant not just for the field of surgery or medicine but for all aspects of our life.

Kudos, Dr. Aloia!

Aloia TA, Should Zero Harm Be Our Goal?, Ann Surg. 2020 Jan;271(1):33-36. doi: 10.1097/SLA.0000000000003316