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01.12.2015 | Debate | Ausgabe 1/2015 Open Access

BMC Surgery 1/2015

Debate: should we use variable adjusted life displays (VLAD) to identify variations in performance in general surgery?

BMC Surgery > Ausgabe 1/2015
Stephen O´Neill, Stephen J. Wigmore, Ewen M. Harrison
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

SON drafting of the manuscript. SJW conception and design, and revision of the manuscript critically for important intellectual content. EMH conception and design, acquisition of data, analysis and interpretation of data, and revision of the manuscript critically for important intellectual content. All authors read and approved the final manuscript.



The recent push for the publication of individual surgeon outcomes underpins public interest in safer surgery. Conventional, retrospective assessment of surgical performance without continuous monitoring may lead to delays in identifying poor performance or recognition of practices that lead to be better than expected performance.


The variable life adjusted display (VLAD) is not new, yet is not widely utilised in General Surgery. Its construction is simple and if caveats are appreciated the interpretation is straightforward, allowing for continuous surveillance of surgical performance.


While limitations in the detection of variations in performance are appreciated, the VLAD could represent a more useful tool for monitoring performance.
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