Surgeon Score Card

It is widely accepted that the risk of surgical complications is influenced by a number of patient, procedure and surgeon factors. Typically, as surgeons we overestimate the impact of surgeon factors on outcomes. However, to consider all relevant factors requires complex mathematical processes, which we usually don’t manage in the midst of our daily lives. For hysterectomy, the patient’s general medical health, their age, obesity, the ASA and whether the patient was able to have a laparoscopic or open surgical procedure are major determinants of outcomes.

By contrast, hospitals, professional societies and often also individual surgeons disregard this information and count every complication as 1. This means that a weighting of complications does not occur, which does do injustice to the reality but also to surgeons who regularly operate on elderly and medically compromised patients. It also underestimates the surgical complication rate of surgeons operating on young and fit patients.

Here’s an example:

Surgeon A has an actual complication rate of 10% and predominantly operates on otherwise healthy patients. Its expected complication rate would be 7%.

Surgeon B also has an actual complication rate of 10% but operates on low and sometimes on high-risk patients. Its expected complication rate is 10%.

Surgeon C also has an actual complication rate of 10% but according to the Surgeon Score card that considers age, ASA and general medical health the expected complication rate would be 13%.

The above example illustrates nicely how inaccurate it is to simply count complications without adjustment.

At SurgicalPerformance we solved this issue by creating a Surgeon Score Card. In collaboration with Professor Val Gebski from the University of Sydney we developed an algorithm that allows users to adjust complication rates for patient factors.

That means that for hysterectomies, actual complication rates get adjusted by multiple confounders. In our above (hypothetical) example, if all three surgeons have a 10% complication rate, surgeon A would be performing worse than surgeon C.

This feature is now available in SurgicalPerformance for hysterectomy procedures.