If surgery is so precise, why are we leaving outcomes up to chance?


It is well known that today there is significant variability in surgical outcomes – not only in different parts of the world, but even within the hospital. And, little understanding as to why. While video is becoming a key component of surgery, up until now, it has gone largely uncaptured, making it impossible for surgeons to surface how different techniques and surgical practices impact quality and efficiency. Compounding the problem – hospitals are data-rich and insight-poor, or DRIP – they have a good understanding of outcomes but no understanding of why some patients suffer complications while others don’t.

However, with the power of AI at the forefront of our minds, is it possible that a solution is imminent? Can we change the paradigm so that no longer, where you live, determines if you live?

Surgeons want to practice evidence-based medicine. They want and need objective ways to assess and enhance performance and efficiency. They need increased transparency. A surgical insights system is the answer. It is the only technology in the marketplace that structures and analyzes copious amounts of surgical video data and integrates it with EHR pre-and-post operative surgical data across a myriad of procedures and specialties, to provide unbiased and actionable data-driven insights, so surgeons can provide their patients with the best possible care.

The first step is to understand, objectively, where variability exists and wherein lies an opportunity for standardization. Take bariatric surgery for example.

Analyzing data gathered from approximately 700 routine sleeve gastrectomy procedures performed by over 140 surgeons from four unique hospitals over the past few months, the surgical insights system uncovered significant surgical variability not only in different hospital systems but also within the same institution. With surgeons taking widely different times to complete procedures and no uniform technique applied, the findings bring to light how even the most nuanced of approaches can have a direct correlation with surgical quality.

While sleeve gastrectomies account for more than half of bariatric surgeries performed in the U.S., the surgical insights system immediately unearthed that not all surgeons adopt the same evidence-based surgical practices. In the data analyzed, while 82 percent of surgeons reinforced the staple line, 18 percent did not; which can lead to complications. Complications for staple line leaks occur in up to 6 percent of patients, yet when surgeons reinforce the staple line, the risk of post-op complications is reduced by half.

The data analysis also highlighted that surgeons across systems are not adopting the same protocols. While surgeons in two of the hospitals packaged patients’ transected stomachs in an endo-bag to reduce the risk of surgical site infection, another group of surgeons from a different hospital only conducted this practice in 0.4 percent of cases. In looking at the number of times drains were inserted in patients, which is a practice that should only happen after a complex procedure or when there is either a high risk of post-op bleeding or a post op leak, we also found that surgeons were inserting drains 61 percent of the time.

The technology also unearthed inefficiencies within the operating room. For example, automated AI analysis of specific steps revealed that, on average, it took surgeons 13.2 minutes to conduct the gastric transection step. However, in 18 of those procedures, it took over 30 minutes. In the longest procedures, regardless of which hospital system they were conducted in, the technology brought to light that patients experienced at least four minutes or more of out of body time. This is the time when the scope was out of the body, leading to prolonged operative time and resulting in increased costs.

“While we know that surgical technique directly impacts outcomes, with little visibility into what’s happening in the operating room, it is challenging for surgeons to learn from and exchange best practices with one another,” said Dr. Gerald Fried, associate dean, educational technology and innovation at McGill University Faculty of Medicine, formerly chair of McGill Department of Surgery, past president of SAGES, past chair of the board of regents of the American College of Surgeons, “as we all strive to deliver optimal care, the ability to extract useful insights is incredibly valuable for health care providers and for hospital systems worldwide.”

With data and insights from its surgical insights system increasingly relied upon by an increasing number of health care centers, hospitals and surgeons are finally able to start to solve this variability in surgical care, and help to not only improve both operational efficiencies and reduce costs across the board, but measure what matters. Outcomes no longer need to be left to chance. We just need the technology to do it.

Tamir Wolf is a physician executive.


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