Becker's Clinical Quality & Infection Control

52 SURGICAL SAFETY Study Finds Surgeon Skill Doesn't Affect Long-Term Outcomes of Bariatric Surgery By Shannon Barnet A lthough surgical skill affects patients' risks for early complications, it does not affect postoperative weight loss or resolution of medical conditions one year fol- lowing laparoscopic gastric bypass, according to a study published in JAMA Surgery. e study was led by Christopher P. Scally, MD, of the University of Michigan in Ann Arbor, and his colleagues. Together, the team conducted a study involving 20 surgeons who performed bariatric surgery and submitted a video of the procedure to the research team. e surgeons were ranked on their skill level through peer video review and categorized into quartiles of skill. Outcomes of bariatric surgery were also examined across surgeon skill levels. All total, more than 3,600 patients underwent surgery with the participating surgeons and had a one-year postoperative follow-up between 2006 and 2012. Highlighted below are five findings from the study. 1. Surgeons in both the top and bottom quar- tiles had each been practicing for roughly 11 years. 2. On a five-point scale, surgical skill scores varied from 2.6 to 4.8, based on peer ratings. 3. e best (top 25 percent) and worst (bot- tom 25 percent) performance quartiles were no different based on excess body weight loss (67 percent vs. 68.5 percent, respectively) one year aer the procedure. 4. Similarly, there were no differences be- tween the best and worst surgeons in resolv- ing sleep apnea (63 percent vs. 62 percent), hypertension (47 percent vs. 45 percent) or hyperlipidemia (52 percent vs. 63 percent). 5. at said, surgeons with the lowest skill rating actually outperformed the high-skill group when it came to rates of diabetes reso- lution (79 percent vs. 73 percent). "Although surgical skill may influence short- term complication rates and patient satis- faction ratings, these findings suggest that long-term outcomes aer bariatric surgery may be more dependent on other factors not yet measured among patients, hospitals or surgeons," wrote the authors. "Future studies should take advantage of video analysis by measuring both operative technique and surgical skill as a means of understanding a surgeon's effect on surgical quality." n Hypothermia During Surgery Associated With Greater Infection Risk By Max Green H ypothermia commonly occurs during surgery and is associated with increased infection risk, according to research from Detroit-based Henry Ford Health System. In 13.2 percent of 1,525 hip fracture surgeries analyzed, patients suffered from unintentional hypothermia. The odds of a deep surgical site infection occurring was 3.3 times higher for patients who developed hypothermia during their procedure. "We know that anesthesia can profoundly affect the body's ability to maintain its internal temperature," Craig Silverton, MD, senior author of the study, said in a state- ment. "What this study demonstrates is that orthopedic patients in their 70s and those with low body mass fur- ther compounds the body to regulate its temperature." Researchers found no correlation between the sex or rates of patients and their likelihood of developing hypothermia during surgery, and note that further re- search is needed to better understand the link between patients for whom a re-warming device is used during surgery to counteract hypothermia and infection. n Patients Undergoing Bladder Cancer Surgery are at Major Risk for Blood Clots, Study Finds By Brian Zimmerman A fter undergoing a radical cystectomy, bladder cancer patients should receive venous throm- boembolism prophylaxis treatment well beyond their hospital discharge, according to a new study in BJU International. In a study comprised of 3,879 bladder cancer patients, researchers found that 3.6 percent of said patients were diagnosed with VTE within one month of surgical admission. This number increased to 4.7 percent at two months and 5.4 percent at three months. Fifty-five percent of these VTE events happened after the patients had been discharged. Patients who undergo this procedure typically no longer receive prophylactic drug treatment to decrease the risk of VTE post-discharge. The study affirmed prior knowledge about the rates of VTE in this particular patient-population. The number of patients diagnosed after hospital discharge surprised the study's authors. The researchers identified few predicative factors in patients who experienced VTE. The study's findings suggest most patients undergoing bladder cancer surgery should receive extended VTE prophylaxis treatment. n

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