Better Surgeons Get Better Results

sharma-obesity-bariatric-surgery21This one may not seem all that earth-shattering but according to a paper by John Birkmeyer and colleagues, published in the New England Journal of Medicine, better surgeons get better results.

the study involved 20 bariatric surgeons in Michigan, who each submitted a single representative videotape of himself or herself performing a laparoscopic gastric bypass, which was then rated by at least 10 of his colleagues (blinded of course) in various domains of technical skill on a scale of 1 to 5 (with higher scores indicating more advanced skill).

This score (ranging between 2.6 and 4.8 across the 20 surgeons) was then compared to risk-adjusted complication rates, using data from a prospective, externally audited, clinical-outcomes registry involving 10,343 patients.

Surgeons rated by their peers as being in the bottom quartile of surgical skill had almost three times higher complication rates and almost five times higher mortality rates than those in the highest skill quartile (14.5% vs. 5.2% and 0.26% vs. 0.05%, respectively).

The lesser skilled surgeons also took longer (137 minutes vs. 98 minutes), their patients were twice as likely to be reoperated (3.4% vs. 1.6%, P=0.01) or readmitted.

This study highlights the wide variability in surgical skill (which can apparently can be judged by other surgeons by watching a single video of the surgeon at work) and the impact that this variation may have in terms of outcome.

Although, I am the first to note that the surgery itself is only one factor in successful outcomes with bariatric surgery, the least you can hope for, is to have the best surgeon perform the procedure.

Montreal, QC

ResearchBlogging.orgBirkmeyer JD, Finks JF, O’Reilly A, Oerline M, Carlin AM, Nunn AR, Dimick J, Banerjee M, Birkmeyer NJ, & the Michigan Bariatric Surgery Collaborative (2013). Surgical Skill and Complication Rates after Bariatric Surgery. The New England journal of medicine, 369 (15), 1434-1442 PMID: 24106936