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.