Jacobs: Not all surgeons created equal
Results of surgery vary depending on who’s holding the knife

Dr. Danny O. Jacobs has expressed what many doctors already know and what many patients may have feared: Not all surgeons are the same.

In his editorial “Cut Well, Sew Well, Do Well?” published this week in the New England Journal of Medicine, the University of Texas Medical Branch provost and dean of the School of Medicine wrote that the high standards of surgical procedure are universally taught in medical school but do not always translate to the operating room.

Jacobs commented on a study, led by Dr. John D. Birkmeyer of the Michigan Bariatric Surgery Collaborative, in which surgeons voluntarily submitted videos of themselves performing laparoscopic gastric bypass. Other surgeons anonymously evaluated these videos for technical proficiency on a scale of 1 to 5.

The bottom 25 percent of those who were evaluated had dramatically higher complication rates, higher mortality rates, longer operations, higher rates of readmission, and higher rates of reoperation compared to the top-ranked quartile.

The findings “strongly suggest that the skill of fully trained, practicing surgeons does influence outcomes,” wrote Jacobs.

Novice surgeons are trained to have sufficient skill, knowledge and judgment so that, through practice, any differences in ability will be standardized.

Yet some surgeons are routinely sought out by patients and esteemed by peers more than others. Jacobs asks, “Why should this be?” Is it technical skill? Then why were there no significant differences in the rate of perforation? Is it case volume? Judgment?

“Regardless, to do the very best for patients, surgeons should enhance their operative effectiveness by any means necessary,” Jacobs wrote. “The background, training, experience, thought processes and technical maneuverings of the best surgeons should be understood and replicated wherever possible with consideration of the influence of the surgical team, hospital, and environmental factors.”

With 691,000 physicians and surgeons practicing as of the 2010 census, and an expected 168,300 more by 2020, the quality of surgeons’ skill and knowledge will certainly continue to be an important issue to researchers and patients.