Association Between Surgeon Technical Skills and Patient Outcomes

Area of Science:

• Surgical Quality Improvement
• Patient Safety
• Health Services Research

Background:

• Postoperative complications are frequent, yet the variability in surgeons' technical skills and its link to patient outcomes is not well understood.
• Assessing operative technical skill is crucial for improving surgical quality and patient safety.

Purpose of the Study:

• To quantify variation in technical skill scores among practicing surgeons.
• To determine the association between surgeon technical skills and patient outcomes.
• To ascertain the proportion of patient outcome variation attributable to surgeon technical skill.

Main Methods:

• 17 practicing surgeons' laparoscopic right hemicolectomy videos were rated by blinded peer surgeons and expert raters.
• Association between technical skill scores and risk-adjusted outcomes was analyzed using American College of Surgeons National Surgical Quality Improvement Program data.
• Robust regression techniques assessed the proportion of outcome variation explained by technical skill scores.

Main Results:

• Technical skill scores ranged from 2.8 to 4.6 (max 5).
• Higher technical skill scores were significantly linked to lower rates of complications (15.5% vs 20.6%), unplanned reoperations (4.7% vs 7.2%), and death or serious morbidity (15.9% vs 21.4%) after colectomy.
• Colectomy technical skill scores predicted outcomes for both colectomy and non-colectomy procedures, explaining 25.8%-27.5% of outcome variation.

Conclusions:

• Significant variation exists in surgeon technical skills, with skill level explaining over 25% of patient outcome variability.
• Enhanced surgeon technical skills, particularly in procedures like colectomy, are associated with improved patient outcomes.
• Targeted efforts to improve surgeon technical skills hold potential for better patient safety and reduced surgical complications.