One of the questions we have been studying and trying to better understand is the relationship between surgical skill and patient outcomes. The rough rule of thumb has always been to ask a surgeon how many of these procedures he or she has done. The logic is that the more surgeries they have performed the better they are likely to be.
Three abstracts were presented that looked at this particular subject at AUA 2017. Two of them leveraged the Michigan Urological Surgery Improvement Collaborative (MUSIC) and one was from a single center study looking at a small cohort of patients from a single surgeon.
High level conclusion:
All three abstracts concluded that there was a relationship between the technical skill of a surgeon and selective patient outcomes. These varied from improved continence at 3 months to reduced urethral catheter replacement for more technically skilled surgeons. There were also suggestions of improved readmission rates as well as decreased blood loss though this was not consistent across all abstracts.
Two of the abstracts were as follows:
Technical Skill Assessment of Surgeons Performing Robot-Assisted Radical Prostatectomy: Relationship Between Crowdsourced Review and Patient Outcomes (Paper# PNFBA-02: Best Abstract – Khurshid R. Ghani et al., Ann Arbor, MI. Read the full study here)
Surgical Skill and Patient Outcomes After Robot-assisted Radical Prostatectomy (Paper# PD58-06: James O. Peabody et al., Detroit, MI. Read the full study here)
Both of these abstracts leveraged the MUSIC database and asked 29 surgeons to provide a video of a case and both used a clip of the vesicourethral anastomosis. Both abstracts also were able to look at results against 2,256 patients. In both instances, the surgeons were reviewed using a Global Evaluative Assessment of Robotic Skills (GEARS) that divided them into quartiles and compared results of the top 25% (Most Skilled) with the bottom 25% (Least Skilled).
The difference between the two papers is that one used the C-SATS platform and crowdsourced the evaluation using 285 reviewers while the other leveraged a group of 56 surgical peers. There is not enough detail in the abstracts to understand the nuance and difference between the reviewers and the scoring achieved.
The results for the crowdsourced study can be seen below:
While the results from the peer reviewed study are seen below:
Given that there is an overlap in a number of the authors in both abstracts, it will be interesting to see if a paper is published that tries to explain these differences.
The third paper was:
Surgical Technical Performance Impacts Patient Outcomes in Robotic-Assisted Radical Prostatectomy (Paper# MP51-15: Mitchell G. Goldenberg, Toronto, Canada; S. Larry Goldenberg, Vancouver, Canada; Teodor P. Grantcharov, Toronto, Canada. Read the full study here)
This looked at 28 case matched patients from one surgeon over a 7 year time period and was reviewed by one surgeon. They also used the GEARS scoring system as well as the Robotic Anastomosis Competency Evaluation (RACE) and the Generic Error Rating Tool (GERT).
They were able to see a correlation between patients who did not achieve continence at three months and the number of errors that occurred during the bladder neck dissection.
Fundamentally these abstracts show that surgical skill matters. The more a surgeon can develop their technical skill set away from a patient, using validated simulation curricula that is driving to proficiency, the better it will be for the patient as well the hospital as fewer readmissions will lead to lower overall costs.
Focused on assisting hospitals to better maximize their investment in robotic surgery, Mimic has over 15 years of experience providing tools and support for robotic surgery training and program support. Contact us today to learn more.