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Surgical Complications Directly Correlated To Surgeons’ Peer-Rated Skill

October 30, 2013

Back in October 2012, this blog published an article called “A Surgeon’s Five Tips for Improving Hospital Safety.” The list was culled from an article written by Johns Hopkins surgeon and professor Marty Makary in The Wall Street Journal, and several of his arguments revolve around the ideas of transparency and reviews of doctors.

His first point is that many people look up reviews of hotels and restaurants on sites like Yelp; why is there not an equivalent for doctors? After all, the stakes are much higher when considering one’s health than one’s lunch plans. He points out that when a similar open access “public reporting” system was implemented in New York in 1989, “death rates declined by 83 percent in six years.” His second point is that hospitals with self-reported rates of good teamwork are more successful than those that do not work well together. He writes that good teamwork “correlated strongly with infection rates and patient outcomes. Good teamwork meant safer care. The public needs to have access to such information for every hospital in America.” His third argument is that hospitals implement cameras in hospital rooms to encourage doctors to perform procedures more carefully and thoroughly.

A recent study in the New England Journal of Medicine combines several of these approaches for determining surgeons’ skill and compares these figures with rates of complication. A team of researchers from the Michigan Bariatric Surgery Collaborative had ten surgeons videotape themselves performing gastric bypass surgeries on obese patients. These videos were then “rated in various domains of technical skill on a scale of 1 to 5 (with higher scores indicating more advanced skill) by at least 10 peer surgeons who were unaware of the identity of the operating surgeon.” The researchers then compared these scores with “risk-adjusted complications rates” from a clinical-outcomes registry involving over 10,000 patients.

The results of the study found that the bottom quartile of surgeons (those most poorly evaluated by their peers) were associated with higher complication rates (14.5 percent) than those in the top quartile (5.2 percent). Moreover, the procedures by the bottom quartile of surgeons resulted in higher mortality rates and longer operations (0.26 percent; 137 minutes) than those performed by the top quartile (0.05 percent; 98 minutes). The better-evaluated doctors also lower rates of readmission and reoperation when compared with those rated as less skilled.

The researchers concluded, “The technical skill of practicing bariatric surgeons varied widely, and greater skill was associated with fewer postoperative complications and lower rates of reoperation, readmission, and visits to the emergency department. Although these findings are preliminary, they suggest that peer rating of operative skill may be an effective strategy for assessing a surgeon’s proficiency.”

Though peer-evaluation was not one of the interventions that Makary suggested in his article, this study’s methods–using cameras to film operations, making the results and complications of such procedures publicly available, and allowing doctors to evaluate other doctors’ performance–effectively implement many of his proposed guidelines. The conclusions of the study speak for themselves, and nothing bad can come of increasing the levels of transparency between doctors and patients, thus creating an additional layer of trust and safety.

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