International Centre for Surgical Safety, Keenan Institute for Biomedical Science, St. Michael's Hospital, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Ann Surg. 2019 Jul;270(1):115-120. doi: 10.1097/SLA.0000000000002741.
The purpose of this study was to evaluate the relationship between technical performance and patient outcomes in laparoscopic gastric cancer surgery.
Laparoscopic gastrectomy for cancer is an advanced procedure with high rate of postoperative morbidity and mortality. Many variables including patient, disease, and perioperative management factors have been shown to impact postoperative outcomes; however, the role of surgical performance is insufficiently investigated.
A retrospective review was performed for all patients who had undergone laparoscopic gastrectomy for cancer at 3 teaching institutions between 2009 and 2015. Patients with available, unedited video-recording of their procedure were included in the study. Video files were rated for technical performance, using Objective Structured Assessments of Technical Skills (OSATS) and Generic Error Rating Tool instruments. The main outcome variable was major short-term complications. The effect of technical performance on patient outcomes was assessed using logistic regression analysis with backward selection strategy.
Sixty-one patients with available video recordings were included in the study. The overall complication rate was 29.5%. The mean Charlson comorbidity index, type of procedure, and the global OSATS score were included in the final predictive model. Lower performance score (OSATS ≤29) remained an independent predictor for major short-term outcomes (odds ratio 6.49), while adjusting for comorbidities and type of procedure.
Intraoperative technical performance predicts major short-term outcomes in laparoscopic gastrectomy for cancer. Ongoing assessment and enhancement of surgical skills using modern, evidence-based strategies might improve short-term patient outcomes. Future work should focus on developing and studying the effectiveness of such interventions in laparoscopic gastric cancer surgery.
本研究旨在评估腹腔镜胃癌手术中技术表现与患者结局之间的关系。
腹腔镜胃癌切除术是一种先进的手术，其术后发病率和死亡率较高。许多变量，包括患者、疾病和围手术期管理因素，已被证明会影响术后结局；然而，手术表现的作用尚未得到充分研究。
对 2009 年至 2015 年间在 3 所教学医院接受腹腔镜胃癌切除术的所有患者进行了回顾性研究。将有可用、未经编辑的手术视频记录的患者纳入研究。使用客观结构化评估技术技能（OSATS）和通用错误评分工具对视频文件进行技术表现评分。主要结局变量为主要短期并发症。使用具有后向选择策略的逻辑回归分析评估技术表现对患者结局的影响。
研究纳入了 61 名有可用视频记录的患者。总并发症发生率为 29.5%。Charlson 合并症指数、手术类型和全球 OSATS 评分均值纳入最终预测模型。较低的表现评分（OSATS≤29）仍然是主要短期结局的独立预测因素（比值比 6.49），同时调整了合并症和手术类型。
腹腔镜胃癌手术中术中技术表现可预测主要短期结局。使用现代基于证据的策略持续评估和提高手术技能可能会改善短期患者结局。未来的工作应集中在开发和研究此类干预措施在腹腔镜胃癌手术中的有效性。
