Video Ratings of Surgical Skill and Late Outcomes of Bariatric Surgery

Abstract

Importance: Measures of surgeons' skills have been associated with variations in short-term outcomes after laparoscopic gastric bypass. However, the effect of surgical skill on long-term outcomes after bariatric surgery is unknown.

Objective: To study the association between surgical skill and long-term outcomes of bariatric surgery.

Design, setting, and participants: In this retrospective observational study, 20 surgeons performing bariatric surgery submitted videos; surgeons were ranked on their skill level through blinded peer video review and sorted into quartiles of skill. Outcomes of bariatric surgery were then examined at the patient level across skill levels. The patients (N = 3631) undergoing surgery with these surgeons had 1-year postoperative follow-up data available between 2006 and 2012. The study was conducted using the Michigan Bariatric Surgery Collaborative, a prospective clinical registry of 40 hospitals performing bariatric surgery in the state of Michigan.

Exposure: Surgeon skill level.

Main outcomes and measures: Excess body weight loss at 1 year; resolution of medical comorbidities (hypertension, sleep apnea, diabetes, and hyperlipidemia), functional status, and patient satisfaction.

Results: Surgeons in the top and bottom quartiles had each been practicing for a mean of 11 years. Peer ratings of surgical skill varied from 2.6 to 4.8 on a 5-point scale. There was no difference between the best (top 25%) and worst (bottom 25%) performance quartiles when comparing excess body weight loss (67.2% vs 68.5%; P = .86) at 1 year. There were no differences in resolution of sleep apnea (62.6% vs 62.0%; P = .77), hypertension (47.1% vs 45.4%; P = .73), or hyperlipidemia (52.3% vs 63.4%; P = .45). Surgeons with the lowest skill rating had patients with higher rates of diabetes resolution (78.8%) when compared with the high-skill group (72.8%) (P = .01).

Conclusions and relevance: In contrast to its effect on early complications, surgical skill did not affect postoperative weight loss or resolution of medical comorbidities at 1 year after laparoscopic gastric bypass. These findings suggest that long-term outcomes after bariatric surgery may be less dependent on a surgeon's operative skill and instead be driven by other factors. Operative technique was not assessed in this analysis and should be considered in future studies.

Figure 1

Risk-adjusted excess body weight loss (%) at one year, according quartile of surgical skill

Figure 2

Risk-adjusted rate of resolution of medical comorbidities, according to quartile of surgical skill