Study examines association between surgical skill and long-term outcomes of bariatric surgery

In contrast to its effect on early complications, surgical skill did not affect postoperative weight loss or resolution of medical conditions at 1 year after laparoscopic gastric bypass, according to a study published online by JAMA Surgery.

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 has been unknown. Christopher P. Scally, M.D., of the University of Michigan, Ann Arbor, and colleagues conducted a study in which 20 surgeons who performed bariatric surgery submitted videos; surgeons were ranked on their skill level through 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 = 3,631) undergoing surgery with these surgeons had 1-year postoperative follow-up data available between 2006 and 2012.

Surgeons in the top and bottom quartiles had each been practicing for an average 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 percent) and worst (bottom 25 percent) performance quartiles when comparing excess body weight loss (67 percent vs 68.5 percent) at 1 year. There were no differences in resolution of sleep apnea (63 percent vs 62 percent), hypertension (47 percent vs 45 percent), or hyperlipidemia (52 percent vs 63 percent). Surgeons with the lowest skill rating had patients with higher rates of diabetes resolution (79 percent) when compared with the high-skill group (73 percent).

"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," the authors write.