How (Exactly) Surgical Skill Impacts Outcomes

It’s generally accepted that surgical skills have an impact on a patient’s outcome. In spite of this assumption, there has been little work to more thoroughly investigate to what extent it has an impact and how we can close that gap. Caresyntax Senior Adviser Dr. John Birkmeyer, along with a team of surgeons from the University of Michigan, set out to explore exactly that.

Measuring the Gap

In order to understand the relationship, Dr. Birkmeyer and his team first needed to establish a way to measure surgical skill. Working with 20 surgeons from the Michigan Bariatric Surgery Collaborative, they asked each participant to submit a video recording of themselves performing a laparoscopic gastric bypass. These videos were each individually assessed anonymously by 10 peer surgeons on a scale of 1(low) to 5(high) and examined 5 technical skills: gentleness, tissue exposure, instrument handling, time and motion, and flow of operation. The average of these scores was used to assess overall surgical finesse.

These assessments were then measured against risk-adjusted complication rates, using data from a prospective, externally-audited, clinical-outcomes registry involving 10,343 patients.

Examining the Results

The study revealed a clear relationship between surgical skill and patient outcomes. Skill sets among the surgeons ranged from 2.6 to 4.8. Comparing surgeons in the bottom quartile with the top quartile revealed significant differences.

The study also revealed that surgical skill did not correlate with number of years as a surgeon, but rather had a stronger relationship with the volume of both general bariatric surgery and of laparoscopic gastric bypass surgeries. Patients who were operated by surgeons in the bottom quartile also had higher levels of surgical site infections and pulmonary complications.

Rethinking Surgical Training

With these results in mind, it’s important to consider what this means for the future of surgical training. Unlike previous studies which compared medical students with attending surgeons, this study examined only examined fully-trained practicing surgeons.

While the study admits that certain aspects of surgery may simply come down to an individual’s raw ability, the study highlights how surgical coaching, continuing education, and peer review can all contribute to improving surgical skill. New technological developments now are helping to assist in recording, reviewing, and annotating surgical procedures, enabling surgeons at all levels to improve their skills.

Through rethinking our approach to how we train surgeons, not just during residency, but across the span of their career, we can help to reduce complications and improve patient outcomes.