Surgical skill and complication rates after bariatric surgery
Open accessAbstract
BACKGROUND: Clinical outcomes after many complex surgical procedures vary widely across hospitals and surgeons. Although it has been assumed that the proficiency of the operating surgeon is an important factor underlying such variation, empirical data are lacking on the relationships between technical skill and postoperative outcomes. METHODS: We conducted a study involving 20 bariatric surgeons in Michigan who participated in a statewide collaborative improvement program. Each surgeon submitted a single representative videotape of himself or herself performing a laparoscopic gastric bypass. Each videotape was rated in various domains of technical skill on a scale of 1 to 5 (with higher scores indicating more advanced skill) by at least 10 peer surgeons who were unaware of the identity of the operating surgeon. We then assessed relationships between these skill ratings and risk-adjusted complication rates, using data from a prospective, externally audited, clinical-outcomes registry involving 10,343 patients. RESULTS: Mean summary ratings of technical skill ranged from 2.6 to 4.8 across the 20 surgeons. The bottom quartile of surgical skill, as compared with the top quartile, was associated with higher complication rates (14.5% vs. 5.2%, P<0.001) and higher mortality (0.26% vs. 0.05%, P=0.01). The lowest quartile of skill was also associated with longer operations (137 minutes vs. 98 minutes, P<0.001) and higher rates of reoperation (3.4% vs. 1.6%, P=0.01) and readmission (6.3% vs. 2.7%) (P<0.001). CONCLUSIONS: The technical skill of practicing bariatric surgeons varied widely, and greater skill was associated with fewer postoperative complications and lower rates of reoperation, readmission, and visits to the emergency department. Although these findings are preliminary, they suggest that peer rating of operative skill may be an effective strategy for assessing a surgeon's proficiency.
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Outcomes after minimally invasive surgery are positively correlated with technical proficiency, experience, and procedural volume of the operator.
“It is well known that due to the aforementioned challenges, among others, outcomes after minimally invasive surgery are positively correlated with technical proficiency, experience, and procedural volume of the operator (Birkmeyer et al., 2013; Pfandler et al., 2019; Hafezi-Nejad et al., 2020; Foley and Hsu, 2021).”
From The Impact of Machine Learning on 2D/3D Registration for Image-Guided Interventions: A Systematic Review and Perspective (2021) · cites this paper as Birkmeyer et al., 2013
The level of expertise is directly related to time spent practicing and is associated with measurable outcome.
“In fact, the level of expertise is directly related to time spent practicing and is associated with measurable outcome.3”
From Neurosurgery resident training using blended learning concepts: Course development and participant evaluation (2022) · cites this paper as [3]
Skills acquired during rigorous simulation-based training improve patient care and safety.
“Skills acquired during rigorous simulation-based training can be transferred to the clinical setting11 and thus improve patient care and safety.12”
From Neurosurgery resident training using blended learning concepts: Course development and participant evaluation (2022) · cites this paper as [3]
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- Authors
- Birkmeyer, J. D., Finks, J. F., O'Reilly, A., Oerline, M., Carlin, A. M., Nunn, A. R., Dimick, J., Banerjee, M., & Birkmeyer, N. J. O.
- Affiliations
- University of Michigan (US)
- Henry Ford Health (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2013-10-10
- Volume
- 369
- Issue
- 15
- Pages
- 1434-1442
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2023276160
- Cited by
- 1,504
- References
- 30
- Citations by year
- 2026: 93 · 2025: 105 · 2024: 120 · 2023: 129 · 2022: 145 · 2021: 134 · 2020: 143 · 2019: 108 · 2018: 103 · 2017: 121 · 2016: 130 · 2015: 99 · 2014: 69 · 2013: 5
- FWCI
- 99.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Surgical Simulation and Training
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Keywords
- bariatric surgery, laparoscopic gastric bypass, surgical skills, peer ratings, postoperative complications, surgical proficiency, risk-adjusted outcomes, hospital variation, reoperation, hospital readmission, operative time, mortality
- MeSH terms
- Adult, Clinical Competence, Female, Humans, Male, Middle Aged, Postoperative Complications, General Surgery, Risk Adjustment, Bariatric Surgery
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