IMPORTANCE Postoperative complications remain common after surgery, but little is known about the extent of variation in operative technical skill and whether variation is associated with patient outcomes.OBJECTIVES To examine the (1) variation in technical skill scores of practicing surgeons, (2) association between technical skills and patient outcomes, and (3) amount of variation in patient outcomes explained by a surgeon's technical skill. DESIGN, SETTING, AND PARTICIPANTSIn this quality improvement study, 17 practicing surgeons submitted a video of a laparoscopic right hemicolectomy that was then rated by at least 10 blinded peer surgeons and 2 expert raters. The association between surgeon technical skill scores and risk-adjusted outcomes was examined using data from the American College of Surgeons National Surgical Quality Improvement Program. The association between technical skill scores and outcomes was examined for colorectal procedures and noncolorectal procedures (ie, assessed on whether technical skills demonstrated during colectomy were associated with patient outcomes across other cases). In addition, the proportion of patient outcomes explained by technical skill scores was examined using robust regression techniques. The study was conducted from September 23, 2016, to February 10, 2018; data analysis was performed from November 2018 to January 2019. EXPOSURES Colorectal and noncolorectal procedures.MAIN OUTCOMES AND MEASURES Any complication, mortality, unplanned hospital readmission, unplanned reoperation related to principal procedure, surgical site infection, and death or serious morbidity. RESULTSOf the 17 surgeons included in the study, 13 were men (76%). The participants had a range from 1 to 28 years in surgical practice (median, 11 years). Based on 10 or more reviewers per video and with a maximum quality score of 5, overall technical skill scores ranged from 2.8 to 4.6. From 2014 to 2016, study participants performed a total of 3063 procedures (1120 colectomies). Higher technical skill scores were significantly associated with lower rates of any complication (15.5% vs 20.6%, P = .03; Spearman rank-order correlation coefficient r = −0.54, P = .03), unplanned reoperation (4.7% vs 7.2%, P = .02; r = −0.60, P = .01), and a composite measure of death or serious morbidity (15.9% vs 21.4%, P = .02; r = −0.60, P = .01) following colectomy. Similar associations were found between colectomy technical skill scores and patient outcomes for all types of procedures performed by a surgeon. Overall, technical skill scores appeared to account for 25.8% of the variation in postcolectomy complication rates and 27.5% of the variation when including noncolectomy complication rates. CONCLUSIONS AND RELEVANCEThe findings of this study suggest that there is wide variation in technical skill among practicing surgeons, accounting for more than 25% of the variation in patient outcomes. Higher colectomy technical skill scores appear to be associated with lower complication rates for colectomy and for all other pr...

Scholars have not fully theorized the multifaceted, interdependent dimensions within the work-family “black box.” Taking an ecology of the life course approach, we theorize common work-family and adequacy constructs as capturing different components of employees' cognitive appraisals of fit between their demands and resources at the interface between home and work. Employees' appraisals of their work-family linkages and of their relative resource adequacy are not made independently but, rather, co-occur as identifiable constellations of fit. The life course approach hypothesizes that shifts in objective demands/ resources at work and at home over the life course result in employees experiencing cycles of control, that is, corresponding shifts in their cognitive assessments of fit. We further theorize patterned appraisals of fit are key mediators between objective work-family conditions and employees' health, well-being and strategic adaptations. As a case example, we examine whether employees' assessments on ten dimensions cluster together as patterned fit constellations, using data from a middle-class sample of 753 employees working at Best Buy's corporate headquarters. We find no single linear construct of fit that captures the complexity within the work-family black box. Instead, respondents experience six distinctive constellations of fit: one optimal, two poor, and three moderate fit constellations.

Supplemental Digital Content is available in the text

Surgical technique is presumed to be an important determinant of patient outcomes. Surgical technical skill, measured by video review, has been associated with postoperative morbidity and histopathologic outcomes. 1-3 However, it is unknown whether technical skill is associated with long-term survival. Our objective was to assess the association between surgical technical skill and overall survival following colectomy for colon cancer.