Gynecologic surgeons: profiling at a glance
Bernhard KA, Siddiqui DS, Louks HA, Chauhan SP. Gynecologic surgeons: profiling at a glance. J Patient-Centered Res Rev. 2014;1:55-56.
Presented at 2013 Aurora Scientific Day, Milwaukee, WI
Background/significance: Surgeon report cards have become a popular approach to surgery quality improvement. Careful consideration must be taken when presenting data on surgeon performance to prevent consumers from drawing incorrect conclusions. The majority of the research on surgeon profiling has occurred in cardiac surgery. From the Cardiac surgery literature, three mechanisms of reporting surgeons; complications are readily used: means, 95% CI, and hierarchical logistic modeling (HLM). There is paucity of studies within the specialty of gynecology.
Purpose: To evaluate the importance of utilizing 95% confidence intervals (CI) in reporting complication rates of gynecologic surgeons. Methods: Surgeons who performed a hysterectomy from July 2007 to December 2011 on women with BMI ≥25 kg/m2. Hysterectomy performed for malignant and obstetrical indications were excluded. The outcome of interest was the overall complication rate which included the surgical, wound, and medical complications. Nonoverlapping 95% CIs were considered significant.
Results: During the four-year study period, 538 hysterectomies were performed by 25 surgeons. The cohort of surgeons had an institutional complication rate of 25%. Comparisons of the means indicated that one surgeon (S1) was an outlier and had significantly higher overall complication rate of 60%. When utilizing the 95% CI method, one surgeon (S6) had a 95% CI (25.1-45.4%) that did not fall within the institutional mean (25%) which was significantly different from the CIs of three surgeons, S19 (95% CI: 6.6-23.2%), S21 (95% CI: 5.0-23.3%), S22 (95% CI: 1.8-23.1%). The remaining 21 surgeons had similar complication rates and 95% CIs that fell within the institutional mean.
Conclusion: Reporting the 95% CI, as opposed to other statistical analyses, allows for greater transparency due to its simplicity and convenience. Utilizing the 95% CI as a reporting method eliminates ranking of surgeons.