Nearly a fifth of operations performed during weekday evenings and 7 per cent of those performed during the daytime and at weekends are performed by unsupervised junior doctors.

These were the recent findings of this year's annual Report by the National Confidential Enquiry into Perioperative Deaths. The report, which results from questionnaires answered by surgeons around the country, attempts to get a rough estimate of how many people die during or soon after surgery, and why. It also examines which surgeries are potentially the most hazardous.

The report highlights concerns that junior doctors are doing out-of-hours operations, not because of the urgency of the patient's condition, but because of lack of time on scheduled waiting lists.

In addition to being operated on by junior surgeons, the patients were anesthetized by trainees, also working without supervision. With all such enquiries, these figures may even underestimate the problem, as they depend on voluntary admissions of surgeons.

The report, Who Operates When?, makes general recommendations about how hospitals should structure their surgical facilities and suggests that senior surgeons should be on call at all times to advise and help in the prioritization of surgical cases (BMJ, 1997; 315: 832).

Unfortunately it does not appear to recommend that, since most of these operations are not urgent, patients should be informed about the qualifications of those who will be operating on or anesthetizing them and thus have the chance to refuse the proposed surgery if they prefer.