Surgeon-Level Variation in Postoperative Complications

Xu, Tim; Makary, Martin A.; Kazzi, Elie S. Al; Zhou, Mo; Pawlik, Timothy M.; Hutfless, Susan

doi:10.1007/s11605-016-3139-6

Cited by 26 publications

(13 citation statements)

References 11 publications

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“…Moreover, we only analyzed surgeries performed by a single surgeon because surgeries performed by different surgeons could have very different outcomes. 18,19 Thus, the results of our study are valid for the strict patient enrollment and large sample size. The lower rates of drainage and unplanned OR return of uniportal VATS were the result of fewer incisions rather than easier cases.…”

Section: Discussionsupporting

confidence: 51%

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Uniportal video‐assisted thoracic surgery could reduce postoperative thorax drainage for lung cancer patients

Qiu

Scarci

et al. 2019

Thoracic Cancer

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Background Uniportal video‐assisted thoracic surgery (VATS) has undergone significant development in recent years, yet its usefulness and value in the treatment of lung cancer remains controversial. We investigated the effect of uniportal VATS surgery for reducing postoperative thorax drainage in lung cancer patients. Methods The data of primary lung cancer patients who underwent VATS anatomical lung resection at the China National Cancer Center by a single surgeon were retrospectively collected. After propensity score matched analysis, 492 patients (246 uniportal VATS, 246 multiportal VATS) were included in the study. The clinicopathologic and surgery‐related features, including drainage volume, were compared. Student's t and chi‐square tests were used; all tests were two‐sided. Results Patients in the two groups had similar demographic and clinicopathological features. Patients who underwent uniportal VATS surgery had significantly lower postoperative thorax drainage (830.0 ± 666.0 mL vs. 1014.5 ± 616.9 mL, P = 0.002) and a comparatively lower rate of unplanned return to the operating room (0 vs. 0.8%; P = 0.156) than multiportal VATS patients. The surgical duration, blood loss, number of lymph nodes dissected, postoperative complications, and length of hospital stay were similar between the groups. Conclusions Uniportal VATS could reduce postoperative thorax drainage and the risk of unplanned return to the operating room for lung cancer patients. This study included the largest sample by a single surgeon and our results suggest the potential value of uniportal VATS for the faster recovery of lung cancer patients.

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Section: Discussionsupporting

confidence: 51%

“…Thus, the surgical difficulty in the two groups is similar. Moreover, we only analyzed surgeries performed by a single surgeon because surgeries performed by different surgeons could have very different outcomes . Thus, the results of our study are valid for the strict patient enrollment and large sample size.…”

Section: Discussionmentioning

confidence: 99%

Uniportal video‐assisted thoracic surgery could reduce postoperative thorax drainage for lung cancer patients

Qiu

Scarci

et al. 2019

Thoracic Cancer

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“…The analysis included 1 884 842 procedures performed by 14 598 surgeons, of whom 9387 (64%) were orthopedic surgeons, 2476 (17%) were general surgeons, 1663 (11%) were urologists, and 1072 (7%) were neurosurgeons ( [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. Seventeen percent of surgeons were affiliated with a for-profit hospital, 50% with an academic hospital (49% of orthopedic surgeons, 46% of urologists, 59% of general surgeons, and 60% of neurosurgeons), and 35% worked in rural settings.…”

Section: Resultsmentioning

confidence: 99%

Association Between Board Certification, Maintenance of Certification, and Surgical Complications in the United States

Mehta

Park

et al. 2019

Am J Med Qual

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Physician credentialing processes aim to improve patient safety and quality, but little research has examined their direct relationship with surgical outcomes. Using national Medicare claims for 2009 to 2013, the authors studied the association between board certification and completion of Maintenance of Certification (MOC) requirements and surgeon rates of complications for 8 elective procedures. Exemplar surgeons were defined as those in the lowest decile of complication rates, and outlier surgeons were those in the highest decile. The analysis included 1.9 million procedures performed by 14 598 surgeons (64% orthopedics, 17% general surgery, 11% urology, 7% neurosurgery). Board-certified surgeons were less likely to be outliers (odds ratio 0.79 [0.66-0.94]). However, completion of MOC was not associated with differences in complication rates in orthopedic surgery or urology. Incorporating additional assessment methods into MOC, such as video evaluation of technical skills, retraining on state-of-the-art care, and peer review, may facilitate further improvements in surgical quality.

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“…Wallenstein et al 10 examined gynecologic laparoscopic procedures specifically, finding that patients undergoing procedures with high-volume surgeons had a lower risk of complication compared with patients undergoing procedures with low-volume surgeons by 25% (risk ratio 0.75, 95% CI 0.68–0.82). On the other hand, studies pertaining to surgical volume in general surgery place emphasis on surgeon use of laparoscopy 11 and surgical volume of the hospital 12,13 as predictors of fewer patient complications.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Surgeons' Perspectives on Risk Factors for and Prophylaxis of Trocar Site Hernias: A Multispecialty National Survey

Wells

Germanos

Salemi

et al. 2019

JSLS

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Background and Objectives: Although trocar site hernias (TSHs) occur in only 1.5% to 1.8% of all laparoscopic procedures, TSHs can present serious postoperative complications. The purpose of this study was to survey surgeons who are active members of the Society of Laparoendoscopic Surgeons (SLS) to elicit their experiences with TSHs, including fascial closure preferences. Methods: After reviewing the clinical and epidemiological literature to compile relevant questions, an anonymous survey was designed using Qualtrics web-based software. The survey link was emailed to all SLS members. Descriptive analyses included frequencies, percentages, and χ 2 or Fisher's exact tests to assess statistical associations. Results: There were 659 SLS members who completed the survey: 323 general surgeons, 242 gynecologists, 45 colorectal surgeons, 25 bariatric surgeons, and 24 urologists. Nearly 7 in 10 respondents (68.4%) reported at least 1 patient developing a TSH within the previous decade. Compared with other specialties, bariatric surgeons had the smallest proportion of respondents reporting fascial closure for 10- to 12-mm trocars (68%) and the largest proportion indicating no fascial closure for trocars of any size (28%) ( P < .01). Among all respondents, 86.6%, 15.3%, and 2.4% close 10- to 12-mm, 8-mm, and 5-mm ports, respectively, without differences according to surgical volume or practice setting. Approximately 6% reported no fascial closure for any size. Conclusion: Port size remains one of the main risk factors for TSH development, with most respondents closing only 10- to 12-mm ports regardless of surgical volume or practice setting. The general trend for port closure for bariatric surgeons is significantly different from that of other surgeons.

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Surgeon-Level Variation in Postoperative Complications

Abstract: Quality metrics in health care have been measured at the hospital level, but a greater quality improvement potential exists at the surgeon level. Awareness of this variation could better inform patients undergoing elective surgery and their referring physicians.

Cited by 26 publications

References 11 publications

Uniportal video‐assisted thoracic surgery could reduce postoperative thorax drainage for lung cancer patients

Uniportal video‐assisted thoracic surgery could reduce postoperative thorax drainage for lung cancer patients

Association Between Board Certification, Maintenance of Certification, and Surgical Complications in the United States

Laparoscopic Surgeons' Perspectives on Risk Factors for and Prophylaxis of Trocar Site Hernias: A Multispecialty National Survey

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