Surgical complications correlate with a surgeon’s skills as rated by his or her surgical peers. A study in the New England Journal of Medicine showed that the complication rates for bariatric surgeons were 3 to 5 times higher for surgeons rated in the lowest quartile (the lowest rated 25% of surgeons evaluated) compared with the highest quartile (the top rated 25% of surgeons evaluated). Twenty bariatric surgeons in Michigan sent in a representative videotape of a laparoscopic gastric bypass they performed and had their surgical skills evaluated by a panel of surgeons who did not know the identity of the surgeons on the videotape. Peer rating of surgical skills was accurate in so far as those surgeons who rated high had surgical complications of 5% compared with surgeons who rated low with complication rates of 15%. The increased surgical complications included leak, obstruction, infection and hemorrhage.
Variations in surgical skill and outcomes may never be eliminated. However just like athletes, deliberate coaching, training and monitoring are essential to improving performance. Video review is a method that provides beneficial one-on-one surgeon coaching. In Michigan, bariatric surgeons now watch each other operate during on-site visits and can watch on-line videos of surgeons with superior skills. The NEJM study had implications for surgical specialty board organizations. Traditional methods for ensuring surgical competence, such as continuing medical education and submission of personal surgical statistics when applying for recertification, do not adequately identify those surgeons whose techniques are below average.
Surgical errors are a major cause of iatrogenic patient injuries and increase health care costs. Surgical societies need to use peer review to assess the competency of surgeons who they certify. Patients should also ask surgeons about their experience with the proposed surgery, as well as what the surgeon’s personal statistics and surgical complications rates are. Given the three fold difference in adverse events between surgeons rated in the top quartile compared with those in the bottom quartile, a peer review monitoring process should be implemented.