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 The findings “suggest that a surgeon’s skill with one operation may
not translate into other seemingly similar operations,”
investigators say.
In the first phase of the research, 20 bariatric surgeons from
across the U.S. had videos taken while they performed gastric bypass
operations to help people lose weight.
Thirty-three other surgeons reviewed the videos and rated them
according to surgical skill, without knowing the identities of the
doctors they were watching.
When the video-based ratings were compared to results in more than
10,000 of the surgeons’ actual patients, “surgeons who were rated
highly by their peers had less complications,” Dr. Oliver Varban of
the University of Michigan Health Systems, Ann Arbor, told Reuters
Health via email.
Therefore, Varban said, his team “asked the next logical question:
‘Can the skill ratings for one procedure (gastric bypass) help us
predict the outcomes for another, similar procedure (sleeve
gastrectomy)?’”
“Our data revealed that it didn’t,” he added.
The surgeons in the gastric bypass videos had been divided by their
peers into top, middle, or bottom categories for skill.
When Varban and colleagues looked back at nearly 7,700 sleeve
gastrectomy surgeries performed by the same 20 surgeons, they found
that all 20 had similar rates of surgical and medical complications,
regardless of how skilled they were at gastric bypass operations.
For instance, overall complication rates after sleeve gastrectomy
were 5.7 percent for top-rated surgeons, 6.4 percent for the middle
surgeons, and 5.5 percent for the bottom, according to a report in
the journal Surgery.
Hospital readmission rates were 3.8 percent for top-rated surgeons,
4.8 percent for the middle surgeons, and 3.1 percent for the bottom.
The reoperation rate was 1.1 percent for all skill levels.
One reason why skill in one surgery didn’t predict skill in another
surgery may be that the operations aren’t similar enough, Dr. James
Ames, Orthopedic Sports Medicine Surgeon at Dartmouth-Hitchcock
Medical Center in Lebanon, New Hampshire told Reuters Health via
phone. Dr. Ames, who wasn’t involved in this research, has studied
whether surgeons’ skill could be transferred between total hip and
partial hip replacement.
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Varban and his colleagues agreed. While both surgeries in this study
are related, some of the skills required aren’t similar, they say.
In a gastric bypass, the top of the stomach is sealed off, leaving a
small pouch that is then connected directly to the middle part of
the small intestine. In a sleeve gastrectomy, the structure of the
stomach is changed to be shaped like a tube.
Both operations restrict the amount of calories the body absorbs –
but one requires more sewing skill while the other requires more
dissection skill. “So, if we are to use video-based skill ratings to
evaluate surgical quality, each procedure needs to be evaluated
separately,” said Varban.
On the bright side, according to Varban, collecting videos of
surgeries helps improve overall surgical quality.
“By combining video-based data with clinical outcomes, we can
determine best practices with regards to technique and set standards
with regard to skill,” he said.
(This version of the story has been refiled to add Dr. Varban's
institution to paragraph 5, and location of Dr. Ames' institution to
paragraph 12.)
SOURCE: http://bit.ly/29imjht Surgery, online June 17, 2016.
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