Do Individual Surgeon Preferences Affect Procedural Outcomes?
Hossein Mohamadipanah, Calvin Perumalla, Su Yang, Brett Wise, Cassidi Goll, LaDonna Kearse, Anna Witt, James R. Korndorffer, Carla Pugh
Surgery, Stanford University School of Medicine, Stanford, California, United States
Objectives: Surgeon preferences such as instrument and suture selection and idiosyncratic approaches to individual procedure steps have been largely viewed as minor differences in the surgical workflow. We hypothesized that idiosyncratic approaches could be quantified and shown to have measurable Affects on procedural outcomes. Methods: At the ACS Clinical Congress, experienced surgeons volunteered to wear motion tracking sensors and be videotaped while evaluating a loop of porcine intestines to identify and repair two pre-configured, standardized enterotomies. Video annotation was used to identify individual surgeon preferences and motion data was used to quantify surgical actions. Chi-square analysis was used to determine whether surgical preferences were associated with procedure outcomes (bowel leak). Results: Surgeonsí (N = 255) preferences were categorized into four technical decisions, Figure 1. Three out of the four technical decisions (repaired injuries together, double layer closure, corner-stitches versus no corner-stitches) played a significant role in outcomes, p<0.05. Running versus interrupted did not affect outcomes. Motion analysis revealed significant differences in average operative times (leak-6.67 min vs. no leak-8.88 min, p=0.0004) and work effort (leak-path length=36.86 cm vs. no leak-path length=49.99 cm, p=0.001). Surgeons who took the riskiest path but did not leak had better bimanual dexterity (leak=0.21/1.0 vs. no leak=0.33/1.0, p=0.47) and placed more sutures during the repair (leak=4.69 sutures vs. no leak=6.09 sutures, p=0.03). Conclusion: Our results show that individual preferences affect technical decisions and play a significant role in procedural outcomes. Future analysis in more complex procedures may make major contributions to our understanding of contributors to patient outcomes.
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