What drove me to create SurgicalPerformance?
I simply wanted an accurate answer to the eternal questions that all performance-minded surgeons ask, “How I am doing? How do I compare with others doing the same procedure?” I needed to know where I stood.
Especially with respect to complications.
Complications, regardless of how frequent or rarely they occur or how unavoidable they may have been, bother me greatly. They upset me, take my sleep away. Having a mechanism to know that I am doing at least as well as my peers… that I am in fact not an outlier, would be greatly reassuring.
The SurgicalPerformance you see today is the result of this ‘needing to know’. It provides massive peace of mind, not just to me, but to an ever-growing cohort of surgeons, who between us have created a robust dataset over 240,000 cases to learn from and compare ourselves against.
For every SurgicalPerformance surgeon, knowing exactly where they stand, gives them huge peace of mind and, as a result, the confidence to keep improving and doing better for their patients.
Peace of mind and confidence, yes! But does it actually improve performance?
As an avid SurgicalPerformance user, I could tangibly see and feel how ‘knowing better’ was helping me thrive as a surgeon personally. As an active researcher, I was keenly curious to see how the entire cohort’s collective outcomes were tracking. I wanted to know: Do surgeons get better the longer they use SurgicalPerformance? Or do they stay pretty much the same? Or do they drop off and get worse? How do our complication rates develop after using SurgicalPerformance for 6 months, 1 year, 3 years?
SurgicalPerformance commissioned an independent statistician to help us answer these questions. We analysed deidentified case records from 156 active SurgicalPerformance users who used our platform since 2014. Our data set comprised of 8458 cases, including hysterectomy, operative hysteroscopy, resection of endometriosis, vulval surgery, myomectomy, pelvic floor repair and adnexal surgery. Of these cases, the mean BMI was 28.1 and 93.2% of patients had an ASA of 1 or 2 (meaning they were otherwise healthy).
We calculated the overall complication rates for 156 surgeons for 20 consecutive 6-month time periods over 10 years.
Here are the results:
At the end of the first year the mean complication rate was 8.2%. That rate decreased slowly to 5.4% after 2 years and remained stable after that until the end of year 10 (end of study period). That is a complication rate reduction of 34%!
We then repeated our analysis in surgeons in a more recent series who used SurgicalPerformance since 2017 and who had a minimum number of complications recorded. This data set comprised of 1592 cases (see Figure below). In this data set complication rates dropped from 12.2% at the end of year 1 to 5.7% at the end of year 4. Wow!
Overall, the complication rate decreased by 45% from the end of year 1 to the end of year 4 of SurgicalPerformance use.
How can we explain such dramatic results?
Given my own experience using SurgicalPerformance, I am not surprised about these results. I believe the most likely reason is that as surgeons and in our mind we begin to process complications differently once we become consciously, concretely aware.
SurgicalPerformance makes me aware of outcomes and once I am aware, I will put actions in place to minimise unwanted outcomes.
While these outcomes may be different from surgeon to surgeon, across all surgical specialties, SurgicalPerformance makes each of us accountable to ourselves. It shows us (and no one else) our unwanted events and stimulates us to take action to become better surgeons. That’s my theory.
An alternative explanation could be ‘The Hawthorne Effect’. This means that if people know that they are observed, they will do better. However, one characteristic of The Hawthorne Effect is that after weeks and months, it wanes. If The Hawthorne Effect would be at play, improvements in surgical complication rates would be short lasting. Whereas in both our series, we found that the reduction in complication rates was more pronounced the longer our surgeons used SurgicalPerformance.
Another explanation could be that surgical complication rates improve over time for all surgeons, regardless of whether they use SurgicalPerformance or not. While I believe such a dramatic decline in complication rates amongst all surgeons is unlikely, we are unable to prove it.
What do we make of this?
While as SurgicalPerformance users we satisfy our own personal drivers (peace of mind, personal risk mitigation, etc), we are at the same time becoming better surgeons.
By looking after ourselves, we are improving our patients’ outcomes.
We all innately ‘know’ these things. Now we know them precisely.