Peer Assessment of Operative Videos with Sleeve Gastrectomy to Determine Optimal Operative Technique.

BACKGROUND: Global assessments of technical skill have been associated with surgical outcomes. More detailed understanding of which specific aspects of technique combine to make the "optimal" sleeve gastrectomy are necessary to help surgeons improve their practice.

STUDY DESIGN: Practicing bariatric surgeons (n = 30) voluntarily submitted a de-identified video of a typical sleeve gastrectomy that was reviewed by a minimum of 10 peer surgeons on the technical quality of 9 operative maneuvers (ie mobilization of the fundus, stapler location, and sleeve width). An "optimal sleeve gastrectomy score" (OSGS) was calculated as a percentage of the total possible optimal maneuvers performed. Risk-adjusted 30-day complication rates and 1-year weight loss were compared between surgeons in the top and bottom quartile for OSGS for all patients who underwent sleeve gastrectomy during the time period.

RESULTS: OSGS ranged from 49.1% to 82.9%. Surgeons in the top quartile for OSGS had lower rates of surgical complications (1.54% vs 2.75%; odds ratio 0.56; 95% CI 0.35 to 0.88; p = 0.013), hemorrhage (0.61% vs 1.48%; odds ratio 0.49; 95% CI 0.28 to 0.86; p = 0.013) and reoperation (0.37% vs 0.91%; odds ratio 0.4; 95% CI 0.20 to 0.81; p = 0.010) compared with surgeons in the bottom quartile. The median bougie size was 34F and the optimal location of the stapler near the pylorus and incisura was 5 cm and 2.25 cm, respectively.

CONCLUSIONS: Sleeve gastrectomy videos thought to have "optimal" technique by peer surgeons were associated with lower complication rates. Understanding how to quantify and assess optimal vs suboptimal techniques can serve as a guide for surgeons to improve their practice.