Research compared 20 surgeons and effects among thousands of patients
By Maureen Salamon
WEDNESDAY, Oct. 9 (HealthDay News) -- Some surgeons are simply better than others, according to new research that links less-skilled weight-loss surgeons to significantly more complications among patients who leave their operating rooms.
Analyzing 20 bariatric surgeons who volunteered to have their operating skills rated via video, University of Michigan researchers found that complication rates of surgeons deemed to be low skilled were 14.5 percent, compared with 5.2 percent among high-skilled surgeons. The study used follow-up data involving more than 10,000 patients.
"Surgeons have known for a long time that some surgeons are naturally more skilled than others, but I think all the members of our study team were surprised by the degree of skill difference across mature, fully trained surgeons," said study author Dr. John Birkmeyer, director of the university's Center for Healthcare Outcomes & Policy. "The findings have really strong implications for how we evaluate and vet which medical school students go on to be surgeons."
The study, which the authors said was the first of its kind to link surgical skill to clinical outcomes, is published Oct. 10 in the New England Journal of Medicine.
Bariatric surgeons participating in the research all performed laparoscopic gastric bypass surgery. In this common but complex procedure, outcomes have been shown to vary widely according to the surgeon.
Based on a single video the surgeons submitted, they were rated anonymously on a scale of one to five, with one representing the skill expected of a general surgery chief resident and five representing the skill of a master surgeon.
Summary ratings by their peers ranged from 2.6 to 4.8. It turned out that low-skilled surgeons logged more postsurgical complications among patients, such as intestinal blockage, infection and blood clots.
Low-skilled surgeons also led operations lasting an average of 137 minutes, compared with 98 minutes for high-skilled surgeons -- an important factor since research has linked prolonged operating times to increased complication risks.
"We always knew surgeons who somehow had better outcomes, whose patients appeared to do better, and the question was: Were those folks so gifted or technically skilled that they just did better?" said Dr. Danny Jacobs, executive vice president and dean of the School of Medicine at the University of Texas Medical Branch, in Galveston.
"Like most really good studies, this one raises more questions than it answers," said Jacobs, who wrote a journal commentary accompanying the study. "It's all pointing to the need to do more studies like this to understand how good surgeons get that way."
Study author Birkmeyer said the findings also suggest that similar evaluations of technical skills might be useful in identifying which medical school students pursue careers as surgeons, or in the recertification process for surgeons already practicing.
Currently, surgical certification and recertification are "influenced primarily by having satisfactory performance on a multiple-choice test and by achieving a certain amount of continuing medical education credits," said Birkmeyer, who also is a professor of surgery. "Those things get at the cognitive side of being a good surgeon ... but at the end of the day, being a good surgeon is also about how skilled you are in the operating room. Right now, we don't do anything with regards to that really crucial aspect."
People interested in finding highly skilled surgeons to perform their own procedures should ask for recommendations from their primary-care physicians, Jacobs said, along with identifying surgeons who often perform the procedure they're undergoing.
The U.S. National Library of Medicine has more about bariatric surgery.
SOURCES: John Birkmeyer, M.D., professor, surgery, and director, Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor; Danny Jacobs, M.D., M.P.H., executive vice president and provost, and dean of the School of Medicine, University of Texas Medical Branch, Galveston; Oct. 10, 2013, New England Journal of Medicine
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