Varban Oliver A, Greenberg Caprice C, Schram Jon, Ghaferi Amir A, Thumma Joythi R, Carlin Arthur M, Dimick Justin B
Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI.
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Surgery. 2016 Nov;160(5):1172-1181. doi: 10.1016/j.surg.2016.04.033. Epub 2016 Jun 17.
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.
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.
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 < .001) and a higher annual volume of bariatric cases per year (top 240, middle 147, bottom 105; P = .001).
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.
近期数据表明，手术技能的同行视频评分与腹腔镜胃旁路手术的临床结局之间存在紧密联系。一种减肥手术的技能是否能够预测另一种相关手术的结局尚不清楚。
20名外科医生自愿提交了标准腹腔镜胃旁路手术的视频，10名或更多同行使用改良版的客观结构化技术技能评估对这些视频进行了盲评。根据进行胃旁路手术的技能将外科医生分为四分位数，并在袖状胃切除术后30天内比较他们的结局。采用多因素逻辑回归分析来调整患者风险因素。
腹腔镜胃旁路手术技能评分处于前四分位数（n = 5）、中间四分位数（n = 10，中间两个四分位数合并）和后四分位数（n = 5）的外科医生，在腹腔镜袖状胃切除术后的手术和医疗并发症发生率相似（前四分位数为5.7%，中间四分位数为6.4%，后四分位数为5.5%，P = 0.13）。此外，外科医生的技能评分与再次手术率、再入院率和急诊就诊率均无相关性。评分最高的外科医生进行袖状胃切除术的手术室时间显著更短（前四分位数为76分钟，中间四分位数为90分钟，后四分位数为88分钟；P < 0.001），且每年的减肥手术病例量更高（前四分位数为240例，中间四分位数为147例，后四分位数为105例；P = 0.001）。
腹腔镜胃旁路手术的手术技能视频评分不能预测腹腔镜袖状胃切除术的结局。一种手术的手术技能评估可能不适用于其他相关手术，可能需要对手术技术熟练程度进行独立评估。
