Correlation of Colorectal Surgical Skill With Patient Outcomes: A Cautionary Tale

Area of Science:

• Colorectal Surgery
• Surgical Education
• Quality Improvement

Background:

• Previous research indicated a link between surgical skill ratings from videos and patient outcomes.
• Video review has been proposed for technical skill assessment, credentialing, and quality improvement in surgery.

Purpose of the Study:

• To determine if video-based skill assessments can predict patient outcomes among specialty colorectal surgeons.
• To evaluate the reliability of video review as a quality measure before its widespread adoption.

Main Methods:

• Twenty-one surgeons submitted videos of minimally invasive colectomies.
• Peer surgeons rated videos using a validated assessment tool.
• Skill ratings were linked to a surgical outcomes registry to assess correlations with risk-adjusted complication rates.

Main Results:

• Average technical skill ratings varied from 2.6 to 4.6; complication rates ranged from 9.9% to 33.1%.
• No statistically significant difference in 30-day risk-adjusted complication rates was found between surgeons in the bottom and top quartiles of skill ratings (17.5% vs 16.8%, p = 0.41).
• Patient demographics differed between quartiles, but this did not translate to outcome differences.

Conclusions:

• Video-based peer rating of minimally invasive colectomy skill did not correlate with postoperative complications in this cohort of specialty surgeons.
• The findings suggest that video review for credentialing and quality improvement in colorectal surgery should be approached with caution.
• Further research may be needed to validate video-based assessments for predicting surgical outcomes.