SU7.1-2 | Surgical Audit and Clinical Research — Summary & Reflection

KEY TAKEAWAYS

Surgery is improved in two distinct ways. Surgical audit is a quality-improvement loop — the audit cycle: set the standard and criteria → measure current practice → compare with the standard → implement change → re-audit to close the loop. It compares practice against an existing standard, tests no hypothesis, and needs no ethics approval. Clinical research is hypothesis-driven and generates new generalisable knowledge; its credibility rests on study design, ranked on the hierarchy of evidence — systematic reviews/meta-analyses of RCTs > RCT > cohort > case-control > cross-sectional > case series > expert opinion. RCTs balance confounders by randomisation; cohort studies look forward (relative risk); case-control studies look backward (odds ratio, good for rare outcomes); cross-sectional studies give prevalence at one moment. Human research requires ethics-committee (IEC/IRB) approval and participant informed consent, which audit does not. Results are read through basic statistics: a p-value <0.05 is conventionally significant (but not necessarily clinically important), and a 95% confidence interval conveys precision — a CI for a ratio that crosses 1 is not significant. The decisive question for any project is always: audit or research?

REFLECT

Think of a quality problem you have seen on a surgical ward — high re-admission, delayed antibiotics, incomplete consent records. How would you turn it into a proper audit: what standard would you set, what would you measure, what change might you make, and when would you re-audit to prove improvement? Now imagine the same topic as a research question instead — what hypothesis would you test, what study design would best answer it, and what would you need to obtain before recruiting a single patient? Finally, recall a study you have read or heard quoted: was it high or low on the hierarchy of evidence, and did the confidence interval actually support the headline claim? How will distinguishing audit from research, and reading statistics critically, change the way you contribute to improving care?