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)
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.
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