Authors’ reply to Das

[...]the development of a composite indicator, based on a set of metrics (such as process quality, safety and efficiency, or patient satisfaction) 3 and a complex adjustment scheme, may lead to biased measurement of surgical performance. 4 Also, qualitative approaches should not substitute for but rather complement the interpretation of objective outcomes measurement when assessing surgical performance. Prospective monitoring of collective and individual outcomes within surgical teams could allow real time detection of safety problems. 6 Exploitation of routinely collected data in hospital information systems now makes such an approach affordable.