Patients of bariatric surgeons deemed to have poor skills by peers who watched them perform a procedure were almost three times more likely to have complications and five times more likely to die than those treated by top-rated surgeons, a study found.

The complication rate among patients treated by surgeons in the bottom quartile was 14.5%, compared with 5.2% among those treated by surgeons in the highest quartile (P<0.001) John D. Birkmeyer, MD, of the University of Michigan Center for Healthcare Outcomes and Policy in Ann Arbor, and colleagues reported.

The mortality rate for patients of the lowest-ranked surgeons was 0.26% versus 0.05% (P=0.01) and operation times averaged 137 minutes compared with 98 minutes (P<0.001), the researchers wrote in the Oct. 10 issue of The New England Journal of Medicine.

Birkmeyer told MedPage Today he was surprised by the strength of the association between the peer-assessed skill rating and surgical outcomes, and he suggested that a strategy similar to the one used in the study could serve as a tool for evaluating competency among bariatric surgeons and other surgeons performing operations that require a high degree of technical skill.

"Many people, including me, assumed skill would have some effect on surgical outcomes, but nobody predicted that the effect would be as strong as it was, or that it would be so consistent across virtually every type of poor outcome," he said.

The fact that the surgeons who participated in the study were also participants in the ongoing Michigan Bariatric Surgery Collaborative (MBSC), a clinical outcomes registry and surgical improvement program, made the research possible, Birkmeyer added.

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