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Surgeon-Level Variation in Postoperative Complications.

Tim Xu1, Martin A Makary2,3, Elie Al Kazzi4

  • 1Departments of Surgery and Medicine, Johns Hopkins School of Medicine, Halsted, 600 N. Wolfe St., Baltimore, MD, 21231, USA.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|April 28, 2016
PubMed
Summary
This summary is machine-generated.

Surgeon skill significantly impacts colectomy outcomes, with laparoscopic surgery use being the strongest predictor of fewer complications. This highlights the potential for surgeon-level quality improvement in healthcare.

Keywords:
PhysicianPostoperative complicationsQualitySurgeryVariation

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Area of Science:

  • Surgical Outcomes Research
  • Health Services Research
  • Quality Improvement in Surgery

Background:

  • Surgical outcome variations are often linked to patient factors, but surgeon-specific quality metrics are less understood.
  • Investigating surgeon-level variations is crucial for improving patient care and surgical quality.

Purpose of the Study:

  • To assess the variation in postoperative complications among surgeons performing elective colectomies.
  • To identify surgeon-specific factors associated with surgical quality and outcomes.

Main Methods:

  • Utilized the Maryland Health Services Cost Review Commission database for risk-adjusted postoperative events.
  • Analyzed elective laparoscopic and open colectomy procedures for colon cancer (July 2012-September 2014).
  • Excluded surgeons with fewer than ten procedures; used logistic regression to calculate observed-to-expected complication ratios.

Main Results:

  • Postoperative complication rates varied more significantly by surgeon (0-30.0%) than by hospital (0-18.2%).
  • Surgeon use of laparoscopic colectomy ranged from 0% to 100%.
  • Laparoscopic surgery adoption was the strongest predictor of reduced complications, independent of surgeon experience, medical school, gender, or annual volume.

Conclusions:

  • Quality improvement initiatives can be enhanced by focusing on surgeon-level performance metrics.
  • Surgeon-level variation in outcomes suggests a significant opportunity for targeted quality improvement.
  • Informing patients and physicians about surgeon-specific quality variations can aid surgical decision-making.