“…On the other hand, there are concerns that the evidence provided by large national databases, audits, and meta-analyses may be biased by the heterogeneity of target populations and procedures performed. 17,18 Often, the spectrum of inclusion criteria is kept rather large to increase sample sizes and no risk adjustment of cases is performed. For example, a profiling algorithm may ascribe a superior performance rank to surgeon A due to an inferior mortality rate compared with surgeon B.…”