Quality improvement study of surgeon skill and perioperative outcomes in robot-assisted partial nephrectomy

Technical skill in complex surgical procedures may affect clinical outcomes A quality improvement study included 10 urological surgeons participating in a surgical collaborative in Michigan. Each surgeon submitted videos of themselves performing robot-assisted partial nephrectomy. Each video was deidentified and evaluated by blinded peer surgeons who also perform robot-assisted partial nephrectomy. The overall perfomance score on a scale from 1 to 5 ranged from 3.5 to 4.7 with a mean of 4.1 ± 0.4 points. Higher technical skill was associated with lower rates of extended hospital stay, high estimated blood loss, positive surgical margins, 30-days emergency visits, and 30-day readmission. Higher annual partial nephrectomy volume was associated with higher technical skill. The authors conclude that these results suggest that video-based evaluation plays a beneficial role in assessing surgical skill and should be considered in quality improvement initiatives to improve patient care.