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Aims  To establish a prospective audit of surgical outcomes in regional and rural surgical practice and a strategy for recognising and managing outliers identified through audit. Methods  Support Scheme for Rural Specialist Funding (SSRS – Round 6) was obtained. Five major centres: Geelong, Ballarat, Bendigo, Wagga Wagga and Lismore agreed to participate in a prospective audit from September 06 to March 07. Various individual surgeons and smaller centres also offered to provide audits of their individual practice (Broome, Bathurst, Wangaratta, Kalgoorlie, Alice Springs). Five operations were audited: colorectal cancer surgery, breast cancer surgery, thyroidectomy, inguinal hernia repair and laparoscopic cholecystectomy. Indicators included mortality, unplanned re‐operation, anastomotic leak, recurrent laryngeal nerve damage, bile leak, postoperative pain for >2 months requiring analgesia or referral to a pain clinic after hernia repair, and the same indicators as the breast cancer audit. Anonymity of surgeons and patients was maintained. Results  At the time of abstract submission all five major sites had appointed project officers. Each centre is contributing about 40+ cases per month. By early December Geelong had collected thyroids (21), laparoscopic cholecystectomy (78 − 2 conversions), breast cancer (17 − 8 mastectomies), adult inguinal hernia repair (38), colorectal surgery (50 − 13 right hemi, 14 anterior resections). Conclusion  It is hoped that the existence of rural surgery craft group audit will provide indicators to assess the outcomes of any individual surgeon who chooses to contribute and compare their performance.

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