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Surgical skill and complication rates after bariatric surgery.

John D Birkmeyer1, Jonathan F Finks, Amanda O'Reilly

  • 1Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109, USA. jbirkmey@umich.edu

The New England Journal of Medicine
|October 11, 2013
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Summary

Surgical skill in bariatric procedures varies significantly. Higher technical skill in surgeons correlates with fewer patient complications, lower mortality, and reduced reoperations, suggesting peer skill assessment is valuable.

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Area of Science:

  • Surgical Outcomes Research
  • Medical Education and Training
  • Bariatric Surgery

Background:

  • Wide variation exists in clinical outcomes for complex surgical procedures across institutions and providers.
  • Surgeon proficiency is hypothesized to influence outcome variability, but empirical data linking technical skill to patient results are limited.

Purpose of the Study:

  • To investigate the relationship between bariatric surgeons' technical skill and patient postoperative outcomes.
  • To determine if objective measures of surgical skill correlate with complication rates and other clinical outcomes.

Main Methods:

  • A statewide study involved 20 bariatric surgeons performing laparoscopic gastric bypass, with videotapes of procedures rated by peer surgeons.
  • Technical skill ratings (1-5 scale) were correlated with risk-adjusted complication rates from a prospective clinical-outcomes registry of 10,343 patients.

Main Results:

  • Significant variation in technical skill ratings (mean 2.6-4.8) was observed among surgeons.
  • The lowest quartile of surgical skill was associated with substantially higher complication rates (14.5% vs. 5.2%), mortality (0.26% vs. 0.05%), longer operative times, and increased reoperation and readmission rates.

Conclusions:

  • Technical skill among practicing bariatric surgeons demonstrates considerable variability.
  • Enhanced surgical skill is linked to improved patient outcomes, including reduced complications, mortality, reoperations, and readmissions.
  • Peer assessment of operative skill may serve as an effective method for evaluating surgeon proficiency.