Do Surgical Skills Affect Outcomes?

Patient outcomes are central to surgical practice, results not only have a significant impact on patients, their families, hospital cost and reputation, but also on the operative surgeons. Many factors influence surgical outcomes; however, for four decades, the volume-outcome relationship has attracted much attention. The importance of this volume-outcome phenomenon has been shown in studies. However, recent research findings have shown that there is a wide variation in the operating skills among fully trained, practising surgeons. That intraoperative surgical skill is a strong predictor of clinical outcomes. The implication of these findings is substantial, as a quality assurance process of intraoperative skills is needed. An enormous amount of resource is allocated to improve a variety of components of the patient's treatment pathway. Still, it appears that little attention and resources are given to a structured, systematic, reproducible and scientific approach targeting the improvement of surgical skills. Objective proficiency-based training and assessments that can apply to specialist surgeons might be utilised to help optimise outcomes. One potential scientific method, the so-called Proficiency-based Progression (PBP) training, has not yet been implemented in colorectal surgery, but in several specialities - has been shown to significantly reduce objectively assessed intra-operative errors (>40%). Undoubtedly other factors, including knowledge, non-technical skills, a team approach in decision making and regular audit, further optimise the care delivered to our patients, but surgeons intraoperative skills remain imperative.