Surgical Skill and Bariatric Surgery: Does Skill In One Procedure Predict Outcomes for Another?

Varban, Oliver A.; Dimick, Justin B.; Carlin, Arthur M.; Thumma, Jyothi R.; Ghaferi, Amir A.; Weiner, Matthew; Hawasli, Abdelkader

doi:10.1016/j.soard.2015.10.015

Cited by 3 publications

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“…This is in contrast to GBP, in which Birkmeyer et al demonstrated that surgeons ranked in the top quartile for surgical skill were found to have lower complication rates when compared to surgeons ranked in the bottom quartile 3 . SG is arguably a less technically challenging procedure than GBP as it does not require creation of an anastomosis, so it is possible that assessments of skill may not influence overall complication rates in a similar fashion 21 . Nevertheless, there are other technical nuances to SG that may influence long-term outcome measures such as weight loss and incidence of new onset gastroesophageal reflux 4,22–24 .…”

Section: Discussionmentioning

confidence: 99%

“…3 SG is arguably a less technically challenging procedure than GBP as it does not require creation of an anastomosis, so it is possible that assessments of skill may not influence overall complication rates in a similar fashion. 21 Nevertheless, there are other technical nuances to SG that may influence long-term outcome measures such as weight loss and incidence of new onset gastroesophageal reflux. 4,[22][23][24] Examples include how ''tight'' or how ''loose'' the SG seems after the procedure or if a hiatal hernia is identified and repaired appropriately at the time of surgery.…”

Section: Discussionmentioning

confidence: 99%

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Evaluating the Impact of Surgeon Self-awareness by Comparing Self Versus Peer Ratings of Surgical Skill and Outcomes for Bariatric Surgery

et al. 2020

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Objective: To evaluate variation in self versus peer-assessments of surgical skill using surgical videos and compare surgeon-specific outcomes with bariatric surgery. Summary Background Data: Prior studies have demonstrated that surgeons with lower peer-reviewed ratings of surgical skill had higher complication rates after bariatric surgery. Methods: This is a retrospective cohort study of 25 surgeons who voluntarily submitted a video of a typical laparoscopic sleeve gastrectomy (SG) between 2015 and 2016. Videos were self and peer-rated using a validated instrument based on a 5-point Likert scale (5¼ ''master surgeon'' and 1¼ ''surgeon-intraining''). Risk adjusted 30-day complication rates were compared between surgeons who over-rated and under-rated their skill based on data from 24,186 SG cases and 12,888 gastric bypass (GBP) cases. Results: individual overall self-rating of surgical skill varied between 2.5 and 5. Surgeons in the top quartile for self:peer ratings (n ¼ 6, ratio 1.58) had lower overall mean peer-scores (2.98 vs 3.79, P ¼ 0.0150) than surgeons in the lowest quartile (n ¼ 6, ratio 0.94). Complication rates between top and bottom quartiles were similar after SG, however leak rates were higher with gastric bypass among surgeons who over-rated their skill with SG (0.65 vs 0.27, P ¼ 0.0181). Surgeon experience was similar between comparison groups. Conclusions and Relevance: Self-perceptions of surgical skill varied widely. Surgeons who over-rated their skill had higher leak rates for more complex procedures. Video assessments can help identify surgeons with poor selfawareness who may benefit from a surgical coaching program.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluating the Impact of Surgeon Self-awareness by Comparing Self Versus Peer Ratings of Surgical Skill and Outcomes for Bariatric Surgery

et al. 2020

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“…8 However, further work within the same surgeon cohort failed to demonstrate a relationship between laparoscopic gastric bypass skill and patient outcomes after laparoscopic sleeve gastrectomy, suggesting a nontransferable skillset. 15 More recently, one study demonstrated that skill at laparoscopic right hemicolectomy predicted improved outcomes for all procedures. Importantly, this study included surgeons with a wide range of expertise, and the majority of surgeons lacked training specific to colon and rectal surgery.…”

Section: Medida De Resultado Principalmentioning

confidence: 99%

“…23 And even within minimally invasive operations, Varban et al found that among bariatric surgical operations, skill assessment for laparoscopic gastric bypass did not predict outcomes of laparoscopic sleeve gastrectomy. 15 In our study, participating surgeons were not limited to a single operation or modality for video review. We felt it was important to analyze a variety of operations to better evaluate whether use of a single video review could be used for evaluation across a larger skill set.…”

Section: Discussionmentioning

confidence: 99%

Correlation of Colorectal Surgical Skill With Patient Outcomes: A Cautionary Tale

Kanters

Evilsizer²,

Regenbogen

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND:Previous work has demonstrated a correlation between video ratings of surgical skill and clinical outcomes. Some have proposed the use of video review for technical skill assessment, credentialing, and quality improvement.OBJECTIVE: Before its adoption as a quality measure for colorectal surgeons, we must first determine whether video-based skill assessments can predict patient outcomes among specialty surgeons.DESIGN: Twenty-one surgeons submitted one representative video of a minimally invasive colectomy. Each video was edited to highlight key steps and then rated by 10 peer surgeons using a validated American Society of Colon and Rectal Surgeons assessment tool. Linking surgeons' ratings to a validated surgical outcomes registry, we assessed the relationship between skill and risk-adjusted complication rates. SETTINGS:The study was conducted with the Michigan Surgical Quality Collaborative, a statewide collaborative including 70 community, academic, and tertiary hospitals.PATIENTS: Patients included those who underwent minimally invasive colorectal resection performed by the participating surgeons. MAIN OUTCOME MEASURES:Main outcome measures included 30-day risk-adjusted postoperative complications. RESULTS:The average technical skill rating for each surgeon ranged from 2.6 to 4.6. Risk-adjusted complication rate per surgeon ranged from 9.9% to 33.1%. Patients of surgeons in the bottom quartile of overall skill ratings were older and more likely to have hypertension or to smoke; patients of surgeons in the top quartile were more likely to be immunosuppressed or have an ASA score of 3 or higher. After patient-and surgery-specific risk adjustment, there was no statistically significant difference in complication rates between the bottom and top quartile surgeons (17.5% vs 16.8%, respectively, p = 0.41).LIMITATIONS: Limitations included retrospective cohort design with short-term follow-up of sampled cases. Videos were edited to highlight key steps, and reviewers did not undergo training to establish norms. CONCLUSIONS:Our study demonstrates that video-based peer rating of minimally invasive colectomy was not correlated with postoperative complications among specialty surgeons. As such, the adoption of video review for use in credentialing should be approached with caution. See Video Abstract at http://links.lww.com/DCR/B802. CORRELACIÓN ENTRE LA HABILIDAD QUIRÚRGICA COLORRECTAL Y LOS RESULTADOS OBTENIDOS EN EL PACIENTE: RELATO PRECAUTORIOANTECEDENTES: Trabajos anteriores han demostrado una correlación entre la video-calificación de la habilidad quirúrgica y los resultados clínicos. Algunos autores han propuesto el uso de la revisión de videos para la

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“…Allerdings ist vollkommen unklar, ob diese Erkenntnis auch auf einfachere Eingriffe wie die Cholezystektomie zutrifft. Einerseits gehört die Cholezystektomie zu den häufigsten Eingriffen in der Chirurgie, andererseits existieren nur sehr wenige Publikationen zum Zusammenhang von Outcome und durchführendem Chirurgen [18,19,20,21,22,23,24]. Die Untersuchungsmethoden in diesen Publikationen sind unterschiedlich und die Ergebnisse zum Teil widersprüchlich.…”

Section: Diskussionunclassified

Der erfahrene Chirurg als unabhängiger Risikofaktor für die Morbidität nach Cholezystektomie. Eine multivariate Analyse von 710 Patienten

Vogel

2022

Zentralbl Chir

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Zusammenfassung Einleitung Bei komplexeren chirurgischen Eingriffen wie der Kolonresektion, herzchirurgischen Eingriffen, arteriellen Rekonstruktionen oder Leberresektionen ist der Einfluss des Chirurgen auf die postoperative Morbidität nachgewiesen. Bei Routineeingriffen wie der Cholezystektomie liegen bislang keine Erkenntnisse zum Zusammenhang von Operateur und Morbidität vor. Insbesondere Untersuchungen bei erfahrenen Chirurgen fehlen. Methoden Es wurden 710 konsekutive Patienten, die zwischen Januar 2014 und Dezember 2018 von erfahrenen Chirurgen (über n = 300 Cholezystektomien vor Beginn der Untersuchung, über 5 Jahre nach bestandener Facharztprüfung) cholezystektomiert wurden, untersucht. In einer univariaten Analyse wurde der Einfluss von Patientenmerkmalen, Laborparametern, chirurgischen Parametern und des Operateurs auf die postoperative Morbidität analysiert. Die Variablen mit statistischer Signifikanzen wurden dann einer multivariaten logistischen Regressionsanalyse unterzogen. Ergebnisse Die Mortalität lag bei 5 von 710 (0,7%), die Morbidität bei 58 von 710 (8,2%). 37 von 710 Patienten erlitten eine chirurgische Komplikation, 21 von 710 Patienten eine nicht chirurgische Komplikation. Hinsichtlich der Gesamtmorbidität waren in multivariater Analyse der Kreatininwert (OR 1,29; KI 1,01–1,648; p = 0,042), GOT (OR 1,0405; KI 1–1,01; p = 0,03), offene und Konversions-Cholezystektomie (OR 4,134; KI 1,587–10,768; p = 0,004) und der individuelle Chirurg (OR bis 40,675; p = 0,001) ein unabhängiger Risikofaktor. Bei Analyse der chirurgischen Komplikationen blieben offene und Konversions-Cholezystektomie (OR 8,104; KI 3,03–21,68; p < 0,001) sowie der individuelle Chirurg (OR bis 79,69; p = 0,005) ein statistisch signifikanter unabhängiger Risikofaktor. Schlussfolgerung Der individuelle Chirurg ist auch bei einem Routineeingriff wie der Cholezystektomie ein unabhängiger Risikofaktor für die Morbidität. Dies gilt auch für erfahrene Chirurgen mit Facharztstatus und hoher Caseload. Im Hinblick auf die Patientensicherheit und Verbesserungen der Ergebnisqualität muss daher diskutiert werden, ob eine routinemäßige risikoadjustierte Messung der individuellen Ergebnisse eines jeden Chirurgen als Basis eines gezielten Qualifizierungprogramms sinnvoll ist.

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Surgical Skill and Bariatric Surgery: Does Skill In One Procedure Predict Outcomes for Another?

Cited by 3 publications

References 0 publications

Evaluating the Impact of Surgeon Self-awareness by Comparing Self Versus Peer Ratings of Surgical Skill and Outcomes for Bariatric Surgery

Evaluating the Impact of Surgeon Self-awareness by Comparing Self Versus Peer Ratings of Surgical Skill and Outcomes for Bariatric Surgery

Correlation of Colorectal Surgical Skill With Patient Outcomes: A Cautionary Tale

Der erfahrene Chirurg als unabhängiger Risikofaktor für die Morbidität nach Cholezystektomie. Eine multivariate Analyse von 710 Patienten

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