Read on Twitter
Excited to share this new paper out in @JAMASurgery.
Our question, in retrospect, seems painfully obvious:
Does WHAT we do in the operating room matter?
Every surgeon knows the answer, but it has been painfully hard to evaluate & improve at scale. (THREAD) https://twitter.com/jdimick1/status/1339555433539747843
Our question, in retrospect, seems painfully obvious:
Does WHAT we do in the operating room matter?
Every surgeon knows the answer, but it has been painfully hard to evaluate & improve at scale. (THREAD) https://twitter.com/jdimick1/status/1339555433539747843
In many years of surgical outcomes research, we've left out some of the most important factors: how the operation is actually done. Surgeons talk about their technique all the time, but we rarely have data to back up very common technical decisions.
Specifically sleeve gastrectomy is becoming one of the most common operations in the US, but outcomes vary in ways that we haven't been able to explain. For instance, 1/3 of patients have new or worsening GERD, and it's challenging to predict who those patients will be.
We used unique data from the @MichBariSC -- surgeons submitted videos of themselves doing sleeves, & rated each other's skill & technique. We then linked peer evaluations to each surgeon's eventual patient outcomes.
We found consistent, significant associations between various domains of technique and patient outcomes at 30 days (bleeding, leaks) and 1 year (weight loss, reflux) from surgery.
Full details in the paper but a summary of the findings here:
Full details in the paper but a summary of the findings here:
Some of these were counterintuitive: eg, making a "tighter" sleeve by stapling the stomach closer to the bougie was not associated with better weight loss, but it was associated with poorer reflux outcomes.
Clearly there's a way to use data to make these decisions, though we frequently fall back on anecdote and how we were trained.
The next step is to use videos in a coaching framework (eg @SurgeonCoaching, @MichBariSC, @MSQCPSO, @ISQIC1) to improve practice across the community.
The next step is to use videos in a coaching framework (eg @SurgeonCoaching, @MichBariSC, @MSQCPSO, @ISQIC1) to improve practice across the community.
Grateful to my mentors @ovarban @jdimick1 @UMichCHOPFellow @UM_IHPI for guiding this work, @JCAlverdy for a fantastic editorial ( https://jamanetwork.com/journals/jamasurgery/article-abstract/2773949), @JAMASurgery for publishing, and @BWHSurgery for teaching me how to operate.
Now let's watch some film!
Now let's watch some film!
