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The goal is always to give them 2 hook hands, 2 peg legs, and an eye patch.  If I'm in late game where I can spare the meds I will have my best doctor tend to the pirate to make sure the surgery goes well.

To deal with the medicine and operation success issue maybe there could be different levels/difficulties of operation just as there are different levels of medicine. For example, installing a bionic leg with all its technology and getting muscles to work with it would take a lot of skill but also decent medicine. Sealing a capping leg that has been shot off at the knee and sticking a wooden stick on the end shouldn't take that much skill or medicine, however as someone previously mentioned, the risk of infection should be higher. Installing an eyepatch shouldn't be as risky as installing a bionic eye (not sure if it actually is but you get the point). Removing an organ should take less skill and meds than installing an organ. Dunno how all that could be coded cause it'd be based on a whole bunch of factors but it's already based on a bunch of factors so why not?

Basically someone would need to add modifiers for each particular action.

Installing an eyepatch should have a modifier of something like 300%, since it does not even involve any actual surgery, which would looks something like 0.93% (at lv10 doctor) x 0.4 Herbal x 3.00 = 116% success.
Installing a peg leg, perhaps something like 200%. (.93x.4x2=74.4%)
New lung, 75% (.93x.4x.75=27.9%)
Bionic Leg, 50% (.93x.4x.50=23.3%)

This way it quickly becomes unrealistic to do anything beyond basic level medical procedures using low tier medicine, while also allowing for a reasonable chance for a good doc to not decapitate someone while applying an eyepatch.

Sorry for the double post, but I needed to report a weird bug that I'm seeing now with the mod enabled.  When I had my best surgeon try to install a peg leg on someone that had their right leg shot off, the surgeon kept repeating the operation until it failed catastrophically.  That is, a successful operation consumed the log and the herbal med, but did not add the peg leg to the character, and the surgery bill was not cleared until the operation failed.

i found the cause of this bug and fixed it so you should be in the clear now

Hmm I guess thats what I was seeing.  I tried on a bunch of prisoners, always resulting in death.  I also tried a bionic jaw removal, which also resulted in death.  This is with a 18 skill doctor using herbal meds, so I suppose thats probably why 100% of my surgeries fail, but it seems rather obscene.

I really enjoyed this mod in the past, but now literally 100% of my surgeries are failing.  I have been 'healing' my prisoners by giving them peg legs and such, however out of >15 operations I have yet to see a single one succeed.  This is with a doctor originally at 15 skill, now at 19.  This seems abysmally low and ridiculous.  Is anyone else seeing this issue? I'm not sure if its mod related or what.