An analysis of data gathered from approximately 700 routine sleeve gastrectomy procedures performed by over 140 surgeons from four unique hospitals over the past few months, has revealed variability and disparity not only in different hospital systems, but also within the same institution. The research, by AI driven health-technology company Theator, found surgeons take widely different times to complete procedures with no uniform technique applied, and that even the most nuanced of approaches can have a direct correlation on surgical quality.
The analysis of SG revealed not all surgeons adopted the same safety milestones. While 82% of procedures reinforced the staple line, 18% did not; which can lead to complications. Complications for staple line leaks occur in up to 6% of patients, yet when surgeons reinforced the staple line, the risk of post-op complications is reduced by half. The analysis also highlighted that surgeons across systems do not follow the same protocols.
While surgeons in two of the hospitals packaged the transected stomach in an endo-bag to reduce the risk of surgical site infection, another group of surgeons from a different hospital only conducted this practice in 0.4% of cases. In looking at the amount of times drains were inserted in patients, which is a practice that should only happen after a complex procedure or when there is either a high risk of post-op bleeding or a post op leak, Theator also found that surgeons were inserting drains 61% of the time.
Theator's analysis also pointed to inefficiencies within the operating room, while many of these metrics were previously unknown, Theator revealed that on average it took surgeons 13.2 minutes to conduct the gastric transection step. However, in 18 of those procedures, it took over 30 minutes, prompting the question of why. Theator also revealed that in the longest procedures, regardless of which hospital system they were conducted in, patients experienced at least four minutes or more of out of body time. This is the time where the scope was out of the body, and literally led to blind spots during surgery, as the surgeons did not see what was happening in the cavity operated on, which then prolonged operative time and resulted in increased costs.
"Despite the popularity of GLP-1 drugs for weight loss, in the past year alone, the demand for bariatric surgery as a durable or permanent treatment of obesity continues to increase," said Dr Gerald Fried, President of SAGES, chair of the board of regents of the American College of Surgeons, Associate Dean, Educational Technology and Innovation at McGill University Faculty of Medicine, formerly chair of McGill Department of Surgery. "Best surgical practices impact outcomes, however, with little visibility into what's happening in the operating room, it has been challenging for surgeons to learn from and exchange best practices with one another. As we all strive to deliver optimal care, Theator's ability to extract useful insights are incredibly valuable for healthcare providers and for hospital systems worldwide."
"At Theator, we are focused on surfacing never-before-seen, real-world data-based findings, that generate actionable insights to positively impact patient outcomes and improve the quality of patient care," said Dr Tamir Wolf, Theator's CEO and Co-Founder. "Through routine analysis of bariatric surgical procedures, our Surgical Intelligence Platform is able to provide hospital systems with a full picture into what's happening intraoperatively, while surfacing, monitoring and standardising surgical best practices, to help not only improve outcomes, but directly link quality of care with cost of care."