Study finds surgeon skill doesn't affect long-term outcomes of bariatric surgery

Although surgical skill affects patients' risks for early complications, it does not affect postoperative weight loss or resolution of medical conditions one year following laparoscopic gastric bypass, according to a study published in JAMA Surgery.

The study was led by Christopher P. Scally, MD, of the University of Michigan in Ann Arbor, and his colleagues. Together, the team conducted a study involving 20 surgeons who performed bariatric surgery and submitted a video of the procedure to the research team.

The surgeons were ranked on their skill level through peer video review and categorized into quartiles of skill. Outcomes of bariatric surgery were also examined across surgeon skill levels. All total, more than 3,600 patients underwent surgery with the participating surgeons and had a one-year postoperative follow-up between 2006 and 2012.

Highlighted below are five findings from the study.

1. Surgeons in both the top and bottom quartiles had each been practicing for roughly 11 years.

2. On a five-point scale, surgical skill scores varied from 2.6 to 4.8, based on peer ratings.

3. The best (top 25 percent) and worst (bottom 25 percent) performance quartiles were no different based on excess body weight loss (67 percent vs. 68.5 percent, respectively) one year after the procedure.

4. Similarly, there were no differences between the best and worst surgeons in resolving sleep apnea (63 percent vs. 62 percent), hypertension (47 percent vs. 45 percent) or hyperlipidemia (52 percent vs. 63 percent).

5. That said, surgeons with the lowest skill rating actually outperformed the high-skill group when it came to rates of diabetes resolution (79 percent vs. 73 percent).

"Although surgical skill may influence short-term complication rates and patient satisfaction ratings, these findings suggest that long-term outcomes after bariatric surgery may be more dependent on other factors not yet measured among patients, hospitals or surgeons," wrote the authors. "Future studies should take advantage of video analysis by measuring both operative technique and surgical skill as a means of understanding a surgeon's effect on surgical quality."



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