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Surgeon's Skill

By Suzanne Potter, PNA Editor

A New York Times blog by Dr. Pauline Chen takes a fascinating look at a recent study done to assess a group of surgeon's skill in the operating room. The study was done by the Michigan Bariatric Surgery Collaborative and published recently in New England Journal of Medicine. Although this study deals with bariatric surgery, the PNA feels that these findings are highly relevant to pituitary surgery. Namely, surgeons with greater skill in the operating room produce better results for patients, who heal faster and have fewer readmissions to the hospital. The researchers asked surgeon-experts to review video tape of 20 anonymous surgeons and rank them on skill, judging which surgeons use the instruments more deftly, work with more fluidity and precision in their motions, and who work more gently with the tissues. Once the researchers produced a ranking, they cross checked that with the surgeons' records of post-op complications. They found that the "surgeons in the bottom quartile took 40 percent more time to complete the same operation and had higher mortality rates than top-ranked surgeons. But their patients also ran a significantly higher chance of developing a whole host of complications, including wound infections, pneumonia, bleeding and thrombophlebitis, and required re-operation and readmission to the hospital after discharge."

The study authors conclude that "the technical skill of practicing bariatric surgeons varied widely, and greater skill was associated with fewer postoperative complications and lower rates of reoperation, readmission, and visits to the emergency department. Although these findings are preliminary, they suggest that peer rating of operative skill may be an effective strategy for assessing a surgeon's proficiency."

Unfortunately, there is no national ranking system that would evaluate surgeons and let patients know which surgeon is the most skilled the operation they seek. We suspect many surgeons would be threatened by such an idea. The PNA has taken a step in that direction by working for years to establish criteria for evaluating Pituitary Centers of Excellence.

To read the full NYT blog, go to:
http://well.blogs.nytimes.com/2013/10/31/a-vital-measure-your-surgeons-skill/?_r=0

To read the original study, go to: http://www.nejm.org/doi/full/10.1056/NEJMsa1300625

 

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