Department of Surgery, University of Michigan, Ann Arbor, Michigan.
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
Ann Surg. 2022 Jul 1;276(1):128-132. doi: 10.1097/SLA.0000000000004450. Epub 2020 Nov 12.
To evaluate variation in self versus peer-assessments of surgical skill using surgical videos and compare surgeon-specific outcomes with bariatric surgery.
Prior studies have demonstrated that surgeons with lower peer-reviewed ratings of surgical skill had higher complication rates after bariatric surgery.
This is a retrospective cohort study of 25 surgeons who voluntarily submitted a video of a typical laparoscopic sleeve gastrectomy (SG) between 2015 and 2016. Videos were self and peer-rated using a validated instrument based on a 5-point Likert scale (5= "master surgeon" and 1= "surgeon-in-training"). Risk adjusted 30-day complication rates were compared between surgeons who over-rated and under-rated their skill based on data from 24,186 SG cases and 12,888 gastric bypass (GBP) cases.
individual overall self-rating of surgical skill varied between 2.5 and 5. Surgeons in the top quartile for self:peer ratings (n = 6, ratio 1.58) had lower overall mean peer-scores (2.98 vs 3.79, P = 0.0150) than surgeons in the lowest quartile (n = 6, ratio 0.94). Complication rates between top and bottom quartiles were similar after SG, however leak rates were higher with gastric bypass among surgeons who over-rated their skill with SG (0.65 vs 0.27, P = 0.0181). Surgeon experience was similar between comparison groups.
Self-perceptions of surgical skill varied widely. Surgeons who over-rated their skill had higher leak rates for more complex procedures. Video assessments can help identify surgeons with poor self-awareness who may benefit from a surgical coaching program.
使用手术视频评估外科医生自我评估和同行评估手术技能的差异，并将其与减重手术的结果进行比较。
先前的研究表明，自我评估手术技能较低的外科医生在接受减重手术后的并发症发生率更高。
这是一项回顾性队列研究，共纳入 25 名自愿在 2015 年至 2016 年间提交典型腹腔镜袖状胃切除术（SG）视频的外科医生。使用基于 5 分制（5=“主刀医生”，1=“实习医生”）的验证工具对视频进行自我和同行评估。根据 24186 例 SG 病例和 12888 例胃旁路术（GBP）病例的数据，比较高估和低估手术技能的外科医生之间 30 天风险调整后并发症发生率。
外科医生自我评估手术技能的整体评分在 2.5 至 5 之间。自我：同行评分处于前四分之一的外科医生（比值 1.58）的总体平均同行评分较低（2.98 比 3.79，P = 0.0150），而评分最低的四分之一外科医生（比值 0.94，n = 6）。SG 后，上四分位组和下四分位组之间的并发症发生率相似，但高估 SG 手术技能的外科医生中胃旁路术的漏诊率较高（0.65 比 0.27，P = 0.0181）。比较组之间的外科医生经验相似。
自我手术技能评估差异很大。高估自己技能的外科医生在进行更复杂的手术时，漏诊率更高。视频评估可以帮助识别自我意识较差的外科医生，他们可能受益于手术辅导计划。
