Technical Performance and Patient Outcomes in Surgery: Another Piece of the Puzzle

Introduction: Patient outcomes depend on a variety of variables related to patients themselves, to disease or treatments. In surgery, operations are the mainstay of management and the operating room is a high-stakes, high-risk environment where the surgeon plays an invaluable role. Extensive literature demonstrates how the aforementioned variables affect patient outcomes, however when it comes to surgeon technical skills, the existing evidence is limited. Therefore the main goal of this thesis was to provide evidence and to emphasize the importance of technical skills and to strengthen the current literature. Material and Methods: Research designs contained within this dissertation include: (1) a systematic review to summarize the existing evidence, (2) a retrospective technical skills analysis, (3) a survey study to define the participants in the operating room and a (4) prospective observational study to determine the relationship between technical and non-technical intraoperative performances. Results: Four research studies were completed. The systematic review demonstrated that technical performance affects patient outcomes, however the quality of evidence is low. The retrospective skill analysis addressed the main methodology deficiencies identified in the review and confirmed that technical performance does affect patient outcomes in laparoscopic gastric cancer operations. The survey study identified that although technical skills have been shown to be important, trainees do not routinely perform the main steps of these operations. Finally, the prospective observational study demonstrated that technical and non-technical performances are related and both are important complements to each other. Conclusion: Technical performance affects patient outcomes. Technical and non-technical performances are related. Ongoing assessment and enhancement of these skills, using modern strategies such as structured feedback, deliberate practice, coaching etc., might improve patient outcomes. Future studies should perform a comprehensive assessment of the operating room and design educational interventions for all participants, regardless of their level of training or experience.Ph.D