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Lingard MCH, Teo Y, Frampton CMA, Hooper GJ. Effect of surgeon-specific feedback on surgical outcomes: a systematic review of the literature. ANZ J Surg 2024; 94:47-56. [PMID: 37962076 DOI: 10.1111/ans.18772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Surgeon-specific outcome reporting provides an opportunity for quality assurance and improved surgical results. It is becoming increasingly prevalent and remains contentious amongst surgeons. The purpose of this systematic review was to evaluate the extent to which published literature supports the concept that feedback of surgeon-level outcomes reduces morbidity and/or mortality. No systematic reviews have previously been completed on this subject. METHODS Medline and Embase were systematically searched for studies published prior to the 1st of January 2022. Feedback was defined as a summary of clinical performance over a specified period of time provided in written, electronic or verbal format. Studies were required to provide surgeon-specific feedback to multiple individual consultant surgeons with the primary purpose being to determine if feedback improved outcomes. Primary outcome(s) needed to relate to surgical outcomes as opposed to process measures only. All surgical specialties and procedures were eligible for inclusion. RESULTS Seventeen studies were included in the review, traversing a wide range of specialties and procedures. Sixteen were non-randominsed and one randomized. Fifteen were before and after studies. The balance of the non-randomized studies support the concept that provision of surgeon-specific feedback can improve surgical outcomes, while the single randomized study suggests feedback may not be effective. CONCLUSIONS This systematic review supports the use of surgeon-level feedback to improve outcomes. The strength of this finding is limited by reliance on before and after studies, further randomized studies on this subject would be insightful.
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Affiliation(s)
- Morgan C H Lingard
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Yahsze Teo
- Te Whatu Ora - Waitaha Canterbury, Canterbury, New Zealand
| | | | - Gary J Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
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Simunovic M, Grubac V, Hillis C, Yang I, Eskicioglu C, Bogach J, Kennedy E, Porter G, Fahim C, Wright J, Aziz T, Tsai S, van der Pol CB, Devereaux PJ, Baker GR. Identification and Adjudication of Adverse Events Following Rectal Cancer Surgery: Observational Case Series in a Region of Ontario, Canada. Ann Surg Oncol 2021; 29:1182-1191. [PMID: 34486089 DOI: 10.1245/s10434-021-10651-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/19/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND For patients undergoing rectal cancer surgery, we evaluated whether suboptimal preoperative surgeon evaluation of resection margins is a latent condition factor-a factor that is common, unrecognized, and may increase the risk of certain adverse events, including local tumour recurrence, positive surgical margin, nontherapeutic surgery, and in-hospital mortality. METHODS In this observational case series of patients who underwent rectal cancer surgery during 2016 in Local Health Integrated Network 4 region of Ontario (population 1.4 million), chart review and a trigger tool were used to identify patients who experienced the adverse events. An expert panel adjudicated whether each event was preventable or nonpreventable and identified potential contributing factors to adverse events. RESULTS Among 173 patients, 25 (14.5%) had an adverse event and 13 cases (7.5%) were adjudicated as preventable. Rate of surgeon awareness of preoperative margin status was low at 50% and similar among cases with and without an adverse event (p = 0.29). Suboptimal surgeon preoperative evaluation of surgical margins was adjudicated a contributing factor in all 11 preventable local recurrence, positive margin, and nontherapeutic surgery cases. Failure to rescue was judged a contributing factor in the two cases with preventable in-hospital mortality. CONCLUSIONS Suboptimal surgeon preoperative evaluation of surgical margins in rectal cancer is likely a latent condition factor. Optimizing margin evaluation may be an efficient quality improvement target.
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Affiliation(s)
- Marko Simunovic
- Department of Surgery, McMaster University, Hamilton, ON, Canada. .,Department of Oncology, McMaster University, Hamilton, ON, Canada. .,Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada.
| | - Vanja Grubac
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Ilun Yang
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Cagla Eskicioglu
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jessica Bogach
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Erin Kennedy
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Geoff Porter
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | | | - James Wright
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Tariq Aziz
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Scott Tsai
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | | | - P J Devereaux
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - G R Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Simunovic M, Baker GR. ASO Author Reflections: Optimizing the Quality of Cancer Surgery-Interrogating Adverse Events for Modifiable Factors in the Preoperative Period. Ann Surg Oncol 2021; 29:1192-1193. [PMID: 34435296 DOI: 10.1245/s10434-021-10654-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Marko Simunovic
- Department of Surgery, McMaster University, Hamilton, Canada.
| | - G Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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