The findings of this study suggest that there is wide variation in technical skill among practicing surgeons, accounting for more than 25% of the variation in patient outcomes. Higher colectomy technical skill scores appear to be associated with lower complication rates for colectomy and for all other procedures performed by a surgeon. Efforts to improve surgeon technical skills may result in better patient outcomes.

Stulberg, J., et al. Association Between Surgeon Technical Skills and Patient Outcomes JAMA Surg. Published online August 19, 2020. doi:10.1001/jamasurg.2020.3007

This study demonstrated the feasibility of using a patient-centered health-data-sharing platform, Hugo, to aggregate multiple real-world data sources in near real time, thereby enabling evaluation of medical products, in this case medical devices, for both research and regulatory purposes and facilitating better understanding of patient recovery, function and symptoms.

Dhruva, S., et al. Aggregating multiple real-world data sources using a patient-centered health-data-sharing platform. npj Digital Medicine volume 3, Article number: 60. 2020.

Use of systematic video review (SVR) in laparoscopic colorectal cancer surgery as an adjunct to the narrative operative report (NR) might be superior in documenting important steps of the operation compared with NR alone, adding to the overall availability of necessary intra-operative information and contributing to quality control and objectivity.

Van de Graaf, F.W., et al. Comparison of Systematic Video Documentation With Narrative Operative Report in Colorectal Cancer Surgery JAMA Surg. Published online January 23, 2019. doi:10.1001/jamasurg.2018.5246

If surgeons want to take the next step at improving the quality of our craft, we need to take advantage of the richest source of data available to us: operative video. Most efforts to improve surgical quality focus on optimizing care before surgery (eg, adhering to evidence-based processes around preventing wound infection and deep venous thrombosis) and the early recognition and treatment of complications to mitigate downstream harm (eg, failure to rescue). While these efforts will improve care, we need to push the frontier to improving what happens in the operating room—the quality of the operation itself.

Dimick, J.B., et al. A Video Is Worth a Thousand Operative Notes JAMA Surg. Published Online: January 23, 2019. doi:10.1001/jamasurg.2018.5247

JAMA Surgery

The surgical workforce is aging. According to the Association of American Medical Colleges Physician Specialty Data Report, in 2017, 44.1% of 103 032 active surgeons in the United States were 55 years or older. The percentage of surgeons 55 years or older varies by surgical specialty, ranging from a low of 40.9% in vascular surgery to a high of 58.1% in thoracic surgery.1 This is an important issue because older surgeons have more experience caring for patients, which needs to be balanced with the potential impairment in their ability to provide high-quality surgical care because of age-related functional limitations.

Mark R. Katlic, MD, JoAnn Coleman, DNP, ACNP-BC, Marcia M. Russell, MD (2019) Assessing the Performance of Aging Surgeons. JAMA Surg. 2019 doi:10.1001/jama.2018.22216

JAMA Surgery

Artificial intelligence (AI) is gaining high visibility in the realm of health care innovation. Broadly defined, AI is a field of computer science that aims to mimic human intelligence with computer systems.1 This mimicry is accomplished through iterative, complex pattern matching, generally at a speed and scale that exceed human capability. Proponents suggest, often enthusiastically, that AI will revolutionize health care for patients and populations. However, key questions must be answered to translate its promise into action.

Thomas M. Maddox, MD, MsC, John S. Rumsfeld, MD, PhD, Philip R. O. Payne, PhD (2018) Questions for Artificial Intelligence in Health Care. JAMA Surg. 2018 doi:10.1001/jama.2018.18932

JAMA Surgery

Artificial intelligence (AI) and deep learning are entering the mainstream of clinical medicine. For example, in December 2016, Gulshan et al1 reported development and validation of a deep learning algorithm for detection of diabetic retinopathy in retinal fundus photographs. An accompanying editorial by Wong and Bressler2 pointed out limits of the study, the need for further validation of the algorithm in different populations, and unresolved challenges (eg, incorporating the algorithm into clinical work flows and convincing clinicians and patients to “trust a ‘black box’”).

William W. Stead, MD (2018) Clinical Implications and Challenges of Artificial Intelligence and Deep Learning. JAMA Surg. 2018. doi:10.1001/jama.2018.11029

JAMA Surgery

During video review of 192 robotic pancreaticoduodenectomies, the angle of the gastrojejunal anastomosis, gastrostomy size, and surgical device style of gastrojejunal anastomosis were technical variables that were associated with postoperative delayed gastric emptying.

Jae Pil Jung, MD, Mazen S. Zenati, MD, PhD, Mashaal Dhir, MD, Amer H. Zureikat, MD, Herbert J. Zeh, MD, Richard L. Simmons, MD, Melissa E. Hogg, MD,MS (2018) Use of Video Review to Investigate Technical Factors That May Be Associated With Delayed Gastric Emptying After Pancreaticoduodenectomy. JAMA Surg. 2018;153(10):918-927. doi:10.1001/jamasurg.2018.2089

The Journal of Bone and Joint Surgery, Incorporated

We educate residents to orchestrate the future delivery of medical and surgical care. However, the tenets and principles of this task vary, resulting in a wide distribution of physician skill, knowledge, and judgment by completion of training1. Surgical training is no exception, and the resultant skills of recent orthopaedic surgery residency graduates are comparatively variable2-4. The potential for uneven skill acquisition has pushed the Accreditation Council for Graduate Medical Education (ACGME), and subsequently the American Board of Orthopaedic Surgery (ABOS), to develop some general standards: the ACGME/ABOS Orthopaedic Surgery Residency Training Milestones5,6.

Kofi D. Agyeman, MD, Seth D. Dodds, MD, Jason S. Klein, MD, Michael G. Baraga, MD, Victor H. Hernandez, MD, and Sheila Conway, MD (2018) Innovation in Residence Education J Bone Joint Surg Am. 2018;100:e90(1-5) d http://dx.doi.org/10.2106/JBJS.17.00839

ScienceDirect

Prolonged operative time is associated with an increase in the risk of complications. Given the adverse consequences of complications, decreased operative times should be a universal goal for surgeons, hospitals, and policy-makers. Future study is recommended on the evaluation of interventions targeted to reducing operating time.

lHang Cheng, MS; Jeffrey W. Clymer, PhD; Brian Po-Han Chen, ScM; Behnam Sadeghirad, PhD; Nicole C. Ferko, MS; Chris G. Cameron, PhD; PietHinoul, MD. (2018) Prolonged Operative Duration is Associated with Complications: A Systematic Review and Meta-Analysis https://doi.org/10.1016/j.jss.2018.03.022

This study demonstrates comprehensively that prolonged operative time can increase the likelihood of developing SSI across a broad array of surgical procedures and surgical specialties. Overall, pooled analyses demonstrated that patients with extended operative times across a wide range of procedures had approximately twice the likelihood of developing SSI, and on overage, the mean operative time was approximately 30 min longer in patients with SSIs compared with those patients without SSIs. Nevertheless, given the importance of SSIs on patient outcome and health care economics including hospital reimbursement penalties, hospitals should focus efforts to reduce operative time. This may include strategies such as the adoption of new technologies that can help improve operative efficiency, utilization of specialized care teams, ensuring that operating staff are not overworked or fatigued, and better preoperative planning. These strategies should be considered in light of other possible risk factors for SSI.

Cheng, H., et al. Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review. Surgical Infections. Aug 2017.722-735. http://doi.org/10.1089/sur.2017.089

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.

Birkmeyer, J.D., et al. for the Michigan Bariatric Surgery Collaborative, Surgical Skill and Complication Rates after Bariatric Surgery The New England Journal of Medicine. Published online October 10, 2013. N Engl J Med 2013; 369:1434-1442

We discovered that crowd-sourced surgery-naïve graders provided assessments equivalent to trained expert surgeon evaluators, and at a faster rate.

Chen C., et al.  Crowd-Sourced Assessment of Technical Skills (C-SATS): Faculty Experts vs. Amazon.com Mechanical Turk Project™ vs. Facebook™. University of Washington School of Medicine, 2012. Medical Student III Poster Session.