Surgeon Variation in Complications With Minimally Invasive and Open Colectomy: Results From the Michigan Surgical Quality Collaborative
Mark A Healy1,2,3, Scott E Regenbogen1,2,3, Arielle E Kanters1,2,3
1Department of Surgery, University of Michigan, Ann Arbor.
Importance:
Minimally invasive colectomy (MIC) is an increasingly common surgical procedure. Although case series and controlled prospective trials have found the procedure to be safe, it is unclear whether safe adaptation of this approach from open colectomy (OC) is occurring among surgeons.
Objective:
To assess rates of complications for MIC compared with OC among surgeons.
Design, Setting, And Participants:
We analyzed 5196 patients who underwent MIC or OC from January 1, 2012, through December 31, 2015, by 97 surgeons in the Michigan Surgical Quality Collaborative, with each surgeon performing at least 10 OCs and 10 MICs. Hierarchical regression was used to assess surgeon variation in adjusted rates of complications and the association of these outcomes across approaches.
Main Outcomes And Measures:
Primary study outcome measurements included overall 30-day complication rates, variation in complication rates among surgeons, and surgeon rank by complication rate for MIC vs OC.
Results:
Of the 5196 patients (mean [SD] age, 62.9 [14.4] years; 2842 [54.7%] female; 4429 [85.2%] white), 3118 (60.0%) underwent MIC and 2078 (40.0%) underwent OC. Overall, 1149 patients (22.1%) experienced complications (702 [33.8%] in the OC group vs 447 [14.3%] in the MIC group; P < .001). For MIC, the rates of complications varied from 8.8% to 25.9% among surgeons. For OC, rates of complications were higher but varied less (1.7-fold) among surgeons, ranging from 25.9% to 43.8%. Among the 97 surgeons ranked, the mean change in ranking between OC and MIC was 25 positions. The top 10 surgeons ranged in rank from 6 of 97 for OC to 89 of 97 for MIC.
Conclusions And Relevance:
Surgeon-level variation in complications was nearly twice as great for MIC than for OC among surgeons enrolled in a statewide quality collaborative. Moreover, surgeon rankings for OC outcomes differed substantially from outcomes for those same surgeons performing MIC. This finding implies a need for improved training in adoption of MIC techniques among some surgeons.
Insights
Surgeon complication rates vary significantly with minimally invasive colectomy (MIC) compared to open colectomy (OC). Improved training is needed as surgeon performance rankings differ substantially between the two colectomy approaches.
Area of Science:
- Colorectal surgery
- Surgical quality and safety
- Minimally invasive surgery
Background:
- Minimally invasive colectomy (MIC) is increasingly adopted, but its safe implementation by surgeons transitioning from open colectomy (OC) requires evaluation.
- Existing studies suggest MIC is safe, yet surgeon-specific complication rates and adaptation challenges remain unclear.
Purpose of the Study:
- To compare complication rates between MIC and OC across a cohort of surgeons.
- To assess the variation in complication rates among individual surgeons for both MIC and OC.
- To analyze the consistency of surgeon performance rankings between MIC and OC.
Main Methods:
- Analysis of 5196 colectomy cases (3118 MIC, 2078 OC) performed by 97 surgeons between 2012-2015.
- Utilized hierarchical regression to evaluate surgeon-level variation in adjusted complication rates.
- Compared 30-day overall complication rates and surgeon rankings for MIC versus OC.
Main Results:
- Overall complication rates were significantly lower for MIC (14.3%) compared to OC (33.8%) (P < .001).
- Surgeon-specific complication rates for MIC varied widely (8.8%-25.9%), with nearly twice the variation observed compared to OC (25.9%-43.8%).
- Surgeon performance rankings differed substantially between MIC and OC, with a mean rank change of 25 positions.
Conclusions:
- Significant variation exists in surgeon-level complication rates for MIC, indicating challenges in adopting the technique.
- Surgeon performance in OC does not consistently predict performance in MIC, highlighting a need for targeted training and quality improvement initiatives.
- The findings underscore the importance of surgeon-specific data and focused education to ensure the safe and effective widespread adoption of minimally invasive colectomy.
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