Correlation of Colorectal Surgical Skill With Patient Outcomes: A Cautionary Tale.
Correlation of Colorectal Surgical Skill With Patient Outcomes: A Cautionary Tale.
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结直肠手术技能与患者结果的相关性：一个警示故事。
DOI：
10.1097/dcr.0000000000002124
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发表时间：
2022
影响因子：
3.9
通讯作者：
Byrn,JohnC
中科院分区：
文献类型：
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作者：
Kanters,ArielleE;Evilsizer,SarahK;Regenbogen,ScottE;Hendren,Samantha;CampbellJr,DarrellA;Dimick,JustinB;Byrn,JohnC
背景：之前的工作已经证明了手术技能的视频评级与临床结果之间的相关性。一些人建议使用视频审查来进行技术技能评估、资格认证和质量改进。 目的：在采用视频审查作为结直肠外科医生的质量衡量标准之前，我们必须首先确定基于视频的技能评估是否可以预测专科外科医生的患者预后。 设计：21 名外科医生提交了一段具有代表性的微创结肠切除术视频。每个视频都经过编辑以突出显示关键步骤，然后由 10 名同行外科医生使用经过验证的美国结肠和直肠外科医生协会评估工具进行评分。将外科医生的评级与经过验证的手术结果登记表联系起来，我们评估了技能与风险调整后的并发症发生率之间的关系。 研究地点：该研究是与密歇根手术质量合作组织一起进行的，该合作组织是一个全州范围的合作组织，包括 70 家社区、学术和三级医院。患者：患者包括接受参与外科医生实施的微创结直肠切除术的患者。 主要结果指标：主要结果指标包括 30 天结果：每位外科医生的平均技术技能评分范围为 2.6 至 4.6。每个外科医生的风险调整并发症发生率在 9.9% 到 33.1% 之间。总体技能评级处于底部四分之一的外科医生的患者年龄较大，更有可能患有高血压或吸烟；前四分之一的外科医生的患者更有可能受到免疫抑制或 ASA 评分为 3 或更高。经过针对患者和手术的特定风险调整后，排名底部和顶部四分位数的外科医生之间的并发症发生率没有统计学上的显着差异（分别为 17.5% 和 16.8%，p = 0.41）。 局限性：局限性包括对样本病例进行短期随访的回顾性队列设计。视频经过编辑以突出关键步骤，审稿人没有接受建立规范的培训。结论：我们的研究表明，基于视频的微创结肠切除术同行评级与专科医生的术后并发症无关。因此，在认证中采用视频审核应谨慎对待。请参阅 https://links 上的视频摘要。 lww。 com/DCR/B802。
BACKGROUND:Previous work has demonstrated a correlation between video ratings of surgical skill and clinical outcomes. Some have proposed the use of video review for technical skill assessment, credentialing, and quality improvement.OBJECTIVE:Before its adoption as a quality measure for colorectal surgeons, we must first determine whether video-based skill assessments can predict patient outcomes among specialty surgeons.DESIGN:Twenty-one surgeons submitted one representative video of a minimally invasive colectomy. Each video was edited to highlight key steps and then rated by 10 peer surgeons using a validated American Society of Colon and Rectal Surgeons assessment tool. Linking surgeons’ ratings to a validated surgical outcomes registry, we assessed the relationship between skill and risk-adjusted complication rates.SETTINGS:The study was conducted with the Michigan Surgical Quality Collaborative, a statewide collaborative including 70 community, academic, and tertiary hospitals.PATIENTS:Patients included those who underwent minimally invasive colorectal resection performed by the participating surgeons.MAIN OUTCOME MEASURES:Main outcome measures included 30-day risk-adjusted postoperative complications.RESULTS:The average technical skill rating for each surgeon ranged from 2.6 to 4.6. Risk-adjusted complication rate per surgeon ranged from 9.9% to 33.1%. Patients of surgeons in the bottom quartile of overall skill ratings were older and more likely to have hypertension or to smoke; patients of surgeons in the top quartile were more likely to be immunosuppressed or have an ASA score of 3 or higher. After patient-and surgery-specific risk adjustment, there was no statistically significant difference in complication rates between the bottom and top quartile surgeons (17.5% vs 16.8%, respectively, p= 0.41).LIMITATIONS:Limitations included retrospective cohort design with short-term follow-up of sampled cases. Videos were edited to highlight key steps, and reviewers did not undergo training to establish norms.CONCLUSIONS:Our study demonstrates that video-based peer rating of minimally invasive colectomy was not correlated with postoperative complications among specialty surgeons. As such, the adoption of video review for use in credentialing should be approached with caution. See Video Abstract at https://links. lww. com/DCR/B802.