Evidence that surgical performance predicts clinical outcomes.

Abstract

Assessment of surgeon performance in the operating room has been identified as a direct method of measuring surgical quality. Studies published in urology and other surgical disciplines have investigated this link directly by measuring surgeon and team performance using methodology supported by validity evidence. This article highlights the key findings of these studies and associated underlying concepts. ​Seminal literature from urology and related areas of research was used to inform this review of the performance-outcome relationship in surgery. Current efforts to further our understanding of this concept are discussed, including relevant quality improvement and educational interventions that utilize this relationship. Evidence from multiple surgical specialties and procedures has established the association between surgeon skill and clinically significant patient outcomes. Novel methods of measuring performance utilize surgeon kinematics and artificial intelligence techniques to more reliably and objectively quantify surgical performance. Future directions include the use of this data to create interventions for quality improvement, as well as innovate the credentialing and recertification process for practicing surgeons.