Surgeons’ Skills Linked to Complication Rates Among Patients

Research suggests that patients are less likely to suffer complications after surgery when their operations are performed by surgeons whose skills are highly rated by other doctors.

Medical researchers at the University of Michigan Health System looked at the relationship between the skills of 20 bariatric surgeons and the rates of post-surgery complications among more than 10,300 patients who underwent gastric bypass surgery, a common but complex procedure.

In a study published in New England Journal of Medicine, the researchers found a strong correlation between the surgeons whose skills were highly rated by fellow doctors and fewer postoperative complications and read missions to the hospital. The surgeons who received low scores for surgical skills had complication rates of 14.5 percent compared to 5.2 percent among the surgeons with highly rated skills. Patients treated by surgeons with low skills ratings were at least twice as likely to die, experience complications, undergo further surgery, and be readmitted to the hospital, the researchers reported.

The surgeons’ skill levels were rated anonymously by other doctors based on a viewing of videotapes that the surgeons had submitted of themselves performing laparoscopic gastric bypass surgery. The skill rating incorporated such factors as time and motion, handling of instruments, gentleness, tissue exposure, and technical skills.

There is a considerable body of research that suggests that some surgeons achieve better results than others, according to the New England Journal article. But few studies have directly assessed the technical skill of surgeons. And according to the researchers, their study is the first to link surgical skill to clinical outcomes.

The researchers found wide variation in the surgeons’ skills.

The surgeons were rated on a scale of 1 to 5, with 1 being the lowest score, associated with the skill of a general surgery chief resident, and 5 being the highest score, denoting the skill of a master surgeon. The surgeons in the study were rated from 2.6 to 4.8.

The study found that surgeries performed by highly rated surgeons took less time than those done by surgeons with lower ratings. Shorter surgeries are associated with a lower risk of complications, while longer-duration surgeries may be associated with a higher risk of bleeding, infections, and the development of dangerous blood clots.

The authors of the study said the findings suggest that formal evaluations of technical skill may be useful for medical board re-certification of practicing surgeons and hospital credentialing for certain procedures.

“In many procedures, the technical skill of the operating surgeon may be more important a determinant of outcomes than perioperative care,” the researchers wrote.

Nonetheless, even experienced, highly skilled surgeons can make surgical errors that injure patients.  The researchers acknowledged that variations in surgical skills and outcomes can never be eliminated.

The attorneys of Morrow Kidman Tinker Macey-Cushman, PLLC represent patients who have been harmed by preventable medical errors in Seattle and across Washington.