Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Feinberg School of Medicine, Northwestern University, Chicago, IL.
Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Feinberg School of Medicine, Northwestern University, Chicago, IL.
J Surg Educ. 2024 Nov;81(11):1568-1576. doi: 10.1016/j.jsurg.2024.07.022. Epub 2024 Sep 6.
Effective technical and nontechnical skills are necessary for surgeons to provide optimal patient care. The aim of this study was to assess the relationship between Nontechnical Skills for Surgeons (NOTSS) and postoperative outcomes among general surgery patients.
This prospective observational study was conducted at a single, large, urban, academic hospital in the USA from February to September 2022. Two raters (an observer and a nurse) assessed each participating surgeon during 3 to 5 different operations. Patient outcome data were collected from the Illinois Surgical Quality Improvement Collaborative (ISQIC) database. We used the American College of Surgeons National Quality Improvement Program (ACS NSQIP) method to calculate risk-adjusted complications. Robust linear regression models were used to assess the association between surgeons' nontechnical skills and risk-adjusted postoperative complications.
Of the 45 surgeons who were observed in the study, 25 (55.5%) had patient outcome data captured by the ISQIC database. The adjusted analysis found that for every unit increase in the NOTSS score, there was a significant 5.1 (95% CI: -8.1; -2.0,p = 0.003), decrease in the adjusted risk of any postoperative complication, a significant 1.1 (95% CI: -1.8; -0.2, p = 0.01) decrease in the adjusted risk of mortality, and significant 1.1 (95% CI: -1.9; -0.4, p = 0.005) decrease in adjusted risks of returning to the operating room.
Higher surgeons' nontechnical skills scores were associated with a decreased risk-adjusted rate of any postoperative complication, mortality, and return to the operating room. Strategies to improve postoperative patient outcomes should include the improvement of surgeons' nontechnical skills.
有效的技术和非技术技能对于外科医生为患者提供最佳护理至关重要。本研究旨在评估外科医生非技术技能（NOTSS）与普外科患者术后结局之间的关系。
这是一项在美国一家大型城市学术医院进行的前瞻性观察性研究，时间为 2022 年 2 月至 9 月。两位评估者（一名观察员和一名护士）在 3 至 5 次不同手术中对每位参与的外科医生进行评估。患者结局数据来自伊利诺伊州手术质量改进合作组织（ISQIC）数据库。我们使用美国外科医师学院国家质量改进计划（ACS NSQIP）方法计算风险调整后的并发症。采用稳健线性回归模型评估外科医生非技术技能与风险调整后术后并发症之间的关联。
在本研究中观察到的 45 名外科医生中，有 25 名（55.5%）的患者结局数据被 ISQIC 数据库捕获。调整后的分析发现，NOTSS 评分每增加一个单位，术后任何并发症的风险调整后显著降低 5.1（95%CI：-8.1；-2.0，p=0.003），死亡率的风险调整后显著降低 1.1（95%CI：-1.8；-0.2，p=0.01），返回手术室的风险调整后显著降低 1.1（95%CI：-1.9；-0.4，p=0.005）。
外科医生非技术技能评分较高与风险调整后任何术后并发症、死亡率和返回手术室的风险降低相关。提高术后患者结局的策略应包括提高外科医生的非技术技能。
