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Association Between Surgeon Technical Skills ...

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

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Prolonged Operative Duration Increases Risk of ...

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

Peer-Reviewed Abstracts
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Facilitating the Safe Diffusion of Surgical ...

This article highlights novel strategies that may assist surgeons and hospitals in addressing the challenges associated with incorporating emerging procedures and technology with safe patient care. Peer coaching by experienced surgeons has been proposed to assist with safe surgical skill acquisition in practice. Hospital credentialing committees may better utilize expert surgeons as proctors for less-experienced surgeons who apply for privileges to perform new procedures. Furthermore, opportunities exist in leveraging industry's financial incentives with surgeons’ drive for clinical advancements. The strategies described in this article offer ways to ensure procedural competency to benefit and protect patients when surgical innovations enter practice.

Pradarelli, J.C., et al. Facilitating the Safe Diffusion of Surgical Innovations Annals of Surgery: April 2019 - Volume 269 - Issue 4 - p 610–611. DOI: 10.1097/SLA.0000000000003134.

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Evolution in surgical training: what can we ...

Surgery already takes lessons from the airline industry and can take similar lessons from professional sport with regards to training. The relationship of a coach and elite sportsman is similar in many respects to that of trainer and trainee. As surgical technology advances, so must the teaching tools and strategies to train the next generation of surgeon.

Chand, M., et al. Evolution in surgical training: what can we learn from professional coaches and elite athletes? J R Soc Med. 2014 Jul; 107(7): 290–292. doi: 10.1177/0141076814532395

Peer-Reviewed Manuscripts
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Correlation of High-Volume Crowdsourced ...

Journal of Endourology

Kowalewski T, Comstock B, Sweet R, Schaffhausen C, Menhadji A, Averch T, Box G, Brand T, Ferrandino M, Kaouk J, Knudsen B, Landman J, Lee B, Schwartz B, McDougall E, Lendvay TS. Correlation of High-Volume Crowdsourced Evaluation and Tool Motion Metrics for Surgical Skills Assessment: The Basic Laparoscopic Urologic Skills (BLUS) Validation Project. Journal of Endourology [in Review, 2016].

2018

Questions for Artificial Intelligence in Health Care

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

Clinical Implications and Challenges of Artificial Intelligence and Deep Learning

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

Use of Video Review to Investigate Technical Factors That May Be Associated With Delayed Gastric Emptying After Pancreaticoduodenectomy

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

Innovations in Resident Education | What Orthopaedic Surgeons Can Learn from Other Disciplines

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

Prolonged Operative Duration is Associated with Complications: A Systematic Review and Meta-Analysis

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