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Bariatric surgeons’ skill doesn’t affect long-term outcomes

Weight loss and resolution of medical conditions unaffected by surgeons’ skill level

Louise Prime

Friday, 15 April 2016

Surgeons’ skill level does not affect the long-term outcomes of laparoscopic gastric bypass, US research has shown. The study,* published online first in JAMA Surgery, showed that one year after surgery neither weight loss nor the resolution of medical conditions (hypertension, sleep apnoea, diabetes, and hyperlipidaemia), were significantly different in people operated on by surgeons who had been independently rated as having the best or worst operating skills.

Surgeons’ skills in this type of surgery have been previously shown to affect short-term outcomes, such as 30-day complication rates. The researchers designed the current study to find out whether or not skill level also had an impact on long-term outcomes.

Twenty surgeons, who had been practising for a mean of 11 years, submitted videos of themselves performing bariatric surgery, and were then grouped into quartiles of skill level after their videos had been reviewed and rated, blind, by peers. Ratings ranged from 2.6 to 4.8 on a 5-point scale. The researchers compared outcomes at one year in 3,631 people who had had laparoscopic bypass surgery performed by these 20 surgeons between 2006 and 2012.

One year after surgery, there was no difference between patients operated on by surgeons in the best and worst quartiles for skill level, in most of the outcomes measured: loss of excess weight (67.2% vs 68.5%); resolution of sleep apnoea (62.6% vs 62.0%); resolution of hypertension (47.1% vs 45.4%); or resolution of hyperlipidaemia (52.3% vs 63.4%). However, patients of those surgeons with the lowest skill rating had higher rates of diabetes resolution (78.8%) than the high-skill group (72.8%).

The researchers commented: “Peer-review ratings of surgical skill did not affect postoperative weight loss or resolution of medical comorbidities at 1 year after laparoscopic gastric bypass. Although surgical skill may influence short-term complication rates and patient satisfaction ratings, these findings suggest that long-term outcomes after bariatric surgery may be more dependent on other factors not yet measured among patients, hospitals, or surgeons. Future studies should take advantage of video analysis by measuring both operative technique and surgical skill as a means of understanding a surgeon’s effect on surgical quality.”

* Scally CP, Varban OA, Carlin AM et al. Video ratings of surgical skill and late outcomes of bariatric surgery. JAMA Surgery. Published online April 13, 2016. doi:10.1001/jamasurg.2016.0428.

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