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Surgical skill in bariatric surgery: Does skill in one procedure predict outcomes for another?

Published on Nov 1, 2016in Surgery3.476
· DOI :10.1016/j.surg.2016.04.033
Oliver A. Varban12
Estimated H-index: 12
(UM: University of Michigan),
Caprice C. Greenberg31
Estimated H-index: 31
(UW: University of Wisconsin-Madison)
+ 4 AuthorsJustin B. Dimick67
Estimated H-index: 67
(UM: University of Michigan)
Abstract
Background Recent data establish a strong link between peer video ratings of surgical skill and clinical outcomes with laparoscopic gastric bypass. Whether skill for one bariatric procedure can predict outcomes for another related procedure is unknown. Methods Twenty surgeons voluntarily submitted videos of a standard laparoscopic gastric bypass procedure, which was blindly rated by 10 or more peers using a modified version of the Objective Structured Assessment of Technical Skills. Surgeons were divided into quartiles for skill in performing gastric bypass, and within 30 days of sleeve gastrectomy, their outcomes were compared. Multivariate logistic regression analysis was utilized to adjust for patient risk factors. Results Surgeons with skill ratings in the top ( n  = 5), middle ( n  = 10, middle 2 combined), and bottom ( n  = 5) quartiles for laparoscopic gastric bypass saw similar rates of surgical and medical complications after laparoscopic sleeve gastrectomy (top 5.7%, middle 6.4%, bottom 5.5%, P  = .13). Furthermore, surgeons' skill ratings did not correlate with rates of reoperation, readmission, and emergency department visits. Top-rated surgeons had significantly faster operating room times for sleeve gastrectomy (top 76 minutes, middle 90 minutes, bottom 88 minutes; P P  = .001). Conclusion Video ratings of surgical skill with laparoscopic gastric bypass do not predict outcomes of laparoscopic sleeve gastrectomy. Evaluation of surgical skill with one procedure may not apply to other related procedures and may require independent assessment of surgical technical proficiency.
  • References (19)
  • Citations (4)
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References19
Newest
#1Hyeyoun Min (UW: University of Washington)H-Index: 1
#2Dianali Rivera Morales (Brigham and Women's Hospital)H-Index: 1
Last. Steven Yule (Harvard University)H-Index: 26
view all 5 authors...
Background There is increasing attention on the coaching of surgeons and trainees to improve performance but no comprehensive review on this topic. The purpose of this review is to summarize the quantity and the quality of studies involving surgical coaching methods and their effectiveness. Methods We performed a systematic literature search through PubMed and PsychINFO by using predefined inclusion criteria. Evidence for main outcome categories was evaluated with the Grading of Recommendations ...
27 CitationsSource
#1Esther M. BonrathH-Index: 13
#2Nicolas J. DedyH-Index: 11
Last. Teodor P. GrantcharovH-Index: 47
view all 4 authors...
available at http://www.ncbi.nlm.nih.gov/pubmed/25822691 Editorial Comment: The concept of surgical coaching is a relatively new idea to help improve training and education for surgeons and surgical residents. In this study 20 residents were ran- domized to undergo either 1) intense coaching during surgery, including ward and operating room duties, regular departmental sessions, performance analysis, debriefing, feedback and behavior modeling, or 2) standard conventional training. Video analysis...
68 CitationsSource
In this issue of Annals of Surgery appear two important papers to advance our understanding of surgical coaching. Bonrath and colleagues report on their randomized controlled trial comparing surgical coaching to standard surgical training for residents on a minimally invasive surgery rotation, using Roux-en-Y gastric bypass as the index procedure.1 In the second study, a survey of attending surgeons by Mutabdzic, et al. explored perceptions of surgical coaching as an approach to performance impr...
22 CitationsSource
#1Pritam SinghH-Index: 10
Last. Ara DarziH-Index: 7
view all 5 authors...
48 CitationsSource
#1Oliver A. Varban (UM: University of Michigan)H-Index: 12
#2Bradley N. Reames (UM: University of Michigan)H-Index: 15
Last. Justin B. Dimick (UM: University of Michigan)H-Index: 67
view all 5 authors...
Abstract Background Over the past decade, there has been a rapid decline in adverse events after bariatric surgery. As a result, it is possible that the influence of hospital volume on outcomes has attenuated over time. The objective of the present study was to examine whether the relationship between hospital volume and adverse events has persisted in the era of laparoscopic surgery. This study is based on analysis of State Inpatient Databases (SID) for 12 states from 2006 through 2011, which i...
10 CitationsSource
#1Bradley N. Reames (UM: University of Michigan)H-Index: 15
#2Jonathan F. Finks (UM: University of Michigan)H-Index: 18
Last. Justin B. Dimick (UM: University of Michigan)H-Index: 67
view all 5 authors...
Bariatric surgery is the most effective therapy available for significant and sustainable weight loss in morbidly obese patients.1,2 As a result of the rising prevalence of obesity, improvements in perioperative safety, and expanded insurance coverage, bariatric surgery utilization has increased in the last decade.3,4 Changes in procedure use over time reflect emerging evidence regarding the comparative safety and effectiveness of available procedures.1,2,5 An understanding of current trends in ...
72 CitationsSource
#1Alana Gebhart (UCI: University of California, Irvine)H-Index: 8
#2Monica Young (UCI: University of California, Irvine)H-Index: 1
Last. Ninh T. Nguyen (UCI: University of California, Irvine)H-Index: 63
view all 4 authors...
Background: Several studies have shown improved outcomes associated with accredited bariatric centers. The aim of our study was to examine the outcomes of bariatric surgery performed at accredited versus nonaccredited centers using a nationally representative database. Additionally, we aimed to determine if the presence of bariatric surgery accreditation could lead to improved outcomes for morbidly obese patients undergoing other general laparoscopic operations. Methods: Using the Nationwide Inp...
31 CitationsSource
#1Bradley N. Reames (UM: University of Michigan)H-Index: 15
#2Amir A. GhaferiH-Index: 26
Last. Justin B. DimickH-Index: 67
view all 4 authors...
Background It is generally accepted that hospital volume is associated with mortality in high-risk procedures. However, as surgical safety has improved over the last decade, recent evidence has suggested that the inverse relationship has diminished or been eliminated.
218 CitationsSource
#1Robert W. Krell (UM: University of Michigan)H-Index: 13
#2Nancy J. O. Birkmeyer (UM: University of Michigan)H-Index: 37
Last. Jonathan F. Finks (UM: University of Michigan)H-Index: 18
view all 6 authors...
Background Although resident involvement has been shown to be safe for most procedures, the impact of residents on outcomes after complex laparoscopic procedures is not well understood. We sought to examine the impact of resident involvement on outcomes after bariatric surgery using a population-based clinical registry. Study Design We analyzed 17,057 patients who underwent a primary laparoscopic gastric bypass in the 35-hospital Michigan Bariatric Surgery Collaborative from July 2006 to August ...
58 CitationsSource
Abstract Background Surgical treatment of morbid obesity with laparoscopic Roux-en-Y gastric bypass (LRYGB) is technically challenging and involves high-risk patients. In this study, the short-term outcome of LRYGB in a large population of patients has been evaluated, and morbimortality before and after overcoming the learning curve has been assessed. The objective of this study was to establish the learning curve for laparoscopic Roux-en-Y gastric bypass. Methods This retrospective study involv...
27 CitationsSource
Cited By4
Newest
#1Aashay Vaidya ('KCL': King's College London)
#2Abdullatif Aydin ('KCL': King's College London)H-Index: 14
Last. Kamran Ahmed (University of Cambridge)H-Index: 43
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Abstract Background Tools for assessment of technical skills are a crucial part of surgical education. They provide trainees with quantitative feedback highlighting both proficiency and areas for improvement. For this to be relevant to day-to-day practice, the tools used have to be validated and relevant to each surgical situation. This study aims to evaluate the validity of assessment tools used within surgery. Materials and methods Following Preferred Reporting Items for Systematic Reviews and...
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#1Vincenzo PiloneH-Index: 14
Last. Mirto FolettoH-Index: 32
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Gastric fistulas, bleeding, and strictures are commonly reported after laparoscopic sleeve gastrectomy (LSG), that increase morbidity and hospital stay and may put the patient’s life at risk. We report our prospective evaluation of application of synthetic sealant, a modified cyanoacrylate (Glubran®2), on suture rime, associated with omentopexy, to identify results on LSG-related complications. Patients were enrolled for LSG by two Bariatric Centers, with high-level activity volume. Intraoperati...
Source
#1Maria S. Altieri (WashU: Washington University in St. Louis)H-Index: 11
#2Aurora D. Pryor (SBU: Stony Brook University)H-Index: 24
Last. Konstantinos Spaniolas (SBU: Stony Brook University)H-Index: 20
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Background There is limited data examining specific annual surgeon procedural volumes associated with improvement of postoperative outcomes following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).
Source
#1Vernissia Tam (University of Pittsburgh)H-Index: 5
#2Devin Rogers (University of Pittsburgh)H-Index: 1
Last. Melissa E. Hogg (University of Pittsburgh)H-Index: 17
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Abstract Background Over the past 5 y, robotic surgery has expanded within general surgery, especially in regard to hernia repairs. We aimed to evaluate the outcomes of the early experience of over 300 consecutive robotic inguinal hernia repairs performed in an academic multihospital system. Methods Consecutive robotic inguinal hernia repairs performed between December 2015 and June 2017 were analyzed. Retrospective chart review was performed, and hospital records were queried. Descriptive stati...
4 CitationsSource
#1Jae Pil Jung (University of Pittsburgh)H-Index: 1
#2Mazen S. Zenati (University of Pittsburgh)H-Index: 28
Last. Melissa E. Hogg (University of Pittsburgh)H-Index: 17
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Importance Technical proficiency at robotic pancreaticoduodenectomy (RPD) and video assessment are promising tools for understanding postoperative outcomes. Delayed gastric emptying (DGE) remains a major driver of cost and morbidity after pancreaticoduodenectomy. Objective To determine if technical variables during RPD are associated with postoperative DGE. Design, Setting, and Participants A retrospective study was conducted of technical assessment performed in all available videos (n = 192) of...
3 CitationsSource
#1Oliver A. Varban (UM: University of Michigan)H-Index: 12
#2Amir A. Ghaferi (UM: University of Michigan)H-Index: 26
Last. Justin B. Dimick (UM: University of Michigan)H-Index: 67
view all 3 authors...
Purpose of Review Bariatric surgery is the most effective and durable treatment for severe obesity. Operative technique for some bariatric procedures can be technically challenging and requires an advanced skill set. Variation in procedure type, operative technique, and surgeon skill can affect outcomes.
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