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. 2023 Apr;37(4):3113-3118.
doi: 10.1007/s00464-022-09480-8. Epub 2022 Aug 4.

Outcome prediction in bariatric surgery through video-based assessment

Poppy Addison  1   2 , Daniel Bitner  3 , Katie Carsky  4   3 , Saratu Kutana  3 , Samuel Dechario  5 , Anthony Antonacci  6 , David Mikhail  4 , Samuel Pettit  7 , Paul J Chung  4   8 , Filippo Filicori  4   3   8
Affiliations

Outcome prediction in bariatric surgery through video-based assessment

Poppy Addison et al. Surg Endosc. 2023 Apr.

Abstract

Introduction: The relationship between intraoperative surgical performance scores and patient outcomes has not been demonstrated at a single-case level. The GEARS score is a Likert-based scale that quantifies robotic surgical proficiency in 5 domains. Given that even highly skilled surgeons can have variability in their skill among their cases, we hypothesized that at a patient level, higher surgical skill as determined by the GEARS score will predict individual patient outcomes.

Methods: Patients undergoing robotic sleeve gastrectomy between July 2018 and January 2021 at a single-health care system were captured in a prospective database. Bivariate Pearson's correlation was used to compare continuous variables, one-way ANOVA for categorical variables compared with a continuous variable, and chi-square for two categorical variables. Significant variables in the univariable screen were included in a multivariable linear regression model. Two-tailed p-value < 0.05 was considered significant.

Results: Of 162 patients included, 9 patients (5.5%) experienced a serious morbidity within 30 days. The average excess weight loss (EWL) was 72 ± 12% at 6 months and 74 ± 15% at 12 months. GEARS score was not significantly correlated with EWL at 6 months (p = 0.349), 12 months (p = 0.468), or serious morbidity (p = 0.848) on unadjusted analysis. After adjusting, total GEARS score was not correlated with serious morbidity (p = 0.914); however, GEARS score did predict EWL at 6 (p < 0.001) and 12 months (p < 0.001). All GEARS subcomponent scores, bimanual dexterity, depth perception, efficiency, force sensitivity, and robotic control were predictive of EWL at 6 months (p < 0.001) and 12 months (p < 0.001) on multivariable analysis.

Conclusion: For patients undergoing sleeve gastrectomy, surgical skill as assessed by the GEARS score was correlated with EWL, suggesting that better performance of a sleeve gastrectomy can result in improved postoperative weight loss.

Keywords: Bariatrics; Outcomes; Robotics; Video-based assessment.

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