• J. Am. Coll. Surg. · Oct 2020

    Peer Assessment of Operative Videos with Sleeve Gastrectomy to Determine Optimal Operative Technique.

    • Oliver A Varban, Jyothi R Thumma, Arthur M Carlin, Jonathan F Finks, Amir A Ghaferi, and Justin B Dimick.
    • Department of Surgery, University of Michigan, MI. Electronic address: ovarban@med.umich.edu.
    • J. Am. Coll. Surg. 2020 Oct 1; 231 (4): 470-477.

    BackgroundGlobal assessments of technical skill have been associated with surgical outcomes. More detailed understanding of which specific aspects of technique combine to make the "optimal" sleeve gastrectomy are necessary to help surgeons improve their practice.Study DesignPracticing bariatric surgeons (n = 30) voluntarily submitted a de-identified video of a typical sleeve gastrectomy that was reviewed by a minimum of 10 peer surgeons on the technical quality of 9 operative maneuvers (ie mobilization of the fundus, stapler location, and sleeve width). An "optimal sleeve gastrectomy score" (OSGS) was calculated as a percentage of the total possible optimal maneuvers performed. Risk-adjusted 30-day complication rates and 1-year weight loss were compared between surgeons in the top and bottom quartile for OSGS for all patients who underwent sleeve gastrectomy during the time period.ResultsOSGS ranged from 49.1% to 82.9%. Surgeons in the top quartile for OSGS had lower rates of surgical complications (1.54% vs 2.75%; odds ratio 0.56; 95% CI 0.35 to 0.88; p = 0.013), hemorrhage (0.61% vs 1.48%; odds ratio 0.49; 95% CI 0.28 to 0.86; p = 0.013) and reoperation (0.37% vs 0.91%; odds ratio 0.4; 95% CI 0.20 to 0.81; p = 0.010) compared with surgeons in the bottom quartile. The median bougie size was 34F and the optimal location of the stapler near the pylorus and incisura was 5 cm and 2.25 cm, respectively.ConclusionsSleeve gastrectomy videos thought to have "optimal" technique by peer surgeons were associated with lower complication rates. Understanding how to quantify and assess optimal vs suboptimal techniques can serve as a guide for surgeons to improve their practice.Copyright © 2020 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…