Key result
Individual surgeons drive a median ~4% of the variance in patient physical health outcomes.
Why the study?
Clinical outcomes of surgical patients with similar prognoses cannot be fully explained by surgeon skill or experience, suggesting potential surgeons' effects that persist after controlling for known variables.
Does the individual surgeon affect patients' physical health outcomes beyond the intervention itself and known confounding variables?
Systematic Review (n=52,436)
Does the individual surgeon affect patients' physical health outcomes beyond the intervention itself and known confounding variables?
There is a measurable 'surgeons' effect' on patients' physical health outcomes that persists after adjusting for known confounding variables, highlighting the importance of individual surgeon performance.
Answers are grounded in this paper and cite their sources.
Surgeon choice may affect post-operative outcomes; extends provider-effect evidence from hospitals and therapists to surgical care.
Objective: To find and review published papers researching surgeons' effects on patients' physical health. Clinical outcomes of surgery patients with similar prognoses cannot be fully explained by surgeon skill or experience. Just as there are "hospital" and "psychotherapist" effects, there may be "surgeons" effects that persist after controlling for known variables like patient health and operation riskiness. Methods: Cohort studies and randomized controlled trials (RCTs) of any surgical intervention, which, after multivariate adjustment, either showed proportion of variance in patients' physical health outcomes due to surgeons (random effects) or graded surgeons from best to worst (fixed effects). Studies with <15 surgeons or only ascribing surgeons' effects to known variables excluded. Medline, PubMed, Embase, and PsycINFO were used for search until June 2020. Manual search for papers referring/referred by resulting studies. Risk of bias assessed by Cochrane risk-of-bias tool and Newcastle-Ottawa Scale. Results: Included studies: 52 cohort studies and three RCTs of 52,436+ surgeons covering 102 outcomes (33 unique). Studies either graded surgeons from best to worst or calculated the intra-class correlation coefficient (ICC), the percentage of patients' variation due to surgeons, in diverse ways. Sixteen studies showed exceptionally good and/or bad performers with confidence intervals wholly above or below the average performance. ICCs ranged from 0 to 47%, median 4.0%. There are no well-established reporting standards; highly heterogeneous reporting, therefore no meta-analysis. Discussion: Interpretation: There is a surgeons' effect on patients' physical health for many types of surgeries and outcomes, ranging from small to substantial. Surgeons with exceptional patient outcomes appear regularly even after accounting for all known confounding variables. Many existing cohort studies and RCTs could be reanalyzed for surgeons' effects especially after methodological reporting guidelines are published. Conclusion: In terms of patient outcomes, it can matter which surgeon is chosen. Surgeons with exceptional patient outcomes are worth studying further.
No takes yet. Share an insight, caveat, or question.
Schnelle et al. (2022) conducted a systematic review in Surgical interventions (n=52,436). Individual surgeon vs. Average surgeon performance was evaluated on Proportion of variance in patients' physical health outcomes due to surgeons (Intra-class correlation coefficient [ICC]) (Median ICC 4.0% (range 0-47%)). Individual surgeons have a measurable effect on patients' physical health outcomes beyond known variables, with the proportion of variance in outcomes due to surgeons ranging from 0% to 47%.
Synapse has enriched 10 related papers. Consider them for comparative context: