Patient outcomes as a measure of surgical technical skills: Does surgical competency matter? A systematic review

INTRODUCTION: The technical skills of surgeons are believed to define the success with which they can perform a surgical procedure. While patient outcomes depend on the skill of the surgeon, other factors may also determine the outcome of a surgical procedure. The extent to which patient outcomes are affected by a surgeon's skill remains to be studied. The aim of this systematic review is to elucidate which procedures show a good correlation between technical skills and patient outcomes and which procedures, if any, do not. EVIDENCE ACQUISITION: A systematic literature search was carried out to identify articles published until May 2016 that drew a correlation between technical skills and patient outcomes. The primary outcome was the effect of the surgeon's skills on patient outcomes. EVIDENCE SYNTHESIS: The final review included 24 objective and 3 subjective studies. Eleven studies reported a positive correlation between surgical skills and patient outcomes; 6 reported no correlation between them; and 10 reported a mix of both positive and negative correlations, or used multiple procedures reporting multiple outcomes. CONCLUSIONS: The level of a surgeon's technical skills is a good predictor of patient outcomes in procedures such as laparoscopic cholecystectomy, laparoscopic appendectomy, and lower extremity amputation among many others. In procedures such as carotid endarterectomy, breast cancer surgery, and a few others, the technical skill of the surgeon seemed to have little effect on patient outcomes. We conclude that the correlation between skills of the surgeon and patient outcome depends on the type of procedure. The procedures that show no correlation between patient outcomes and surgical competence need to be studied further not only to improve patient outcomes but also to redefine the goal of training.