Outcome prediction in bariatric surgery through video-based assessment

• Published in: Surgical endoscopy Vol. 37; no. 4; pp. 3113 - 3118
• Main Authors: Addison, Poppy, Bitner, Daniel, Carsky, Katie, Kutana, Saratu, Dechario, Samuel, Antonacci, Anthony, Mikhail, David, Pettit, Samuel, Chung, Paul J., Filicori, Filippo
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-04-2023; Springer Nature B.V
• Subjects: 2022 SAGES Oral; Abdominal Surgery; Analysis of Variance; Bariatric Surgery; Databases, Factual; Gastrectomy; Gastroenterology; Gastrointestinal surgery; Gynecology; Hepatology; Humans; Medicine; Medicine & Public Health; Morbidity; Patients; Proctology; Prognosis; Robotic surgery; Surgery; Surgical outcomes; Video-based assessment; Outcomes; Robotics; Bariatrics
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-022-09480-8

Introduction
The relationship between intraoperative surgical performance scores and patient outcomes has not been demonstrated at a single-case level. The GEARS score is a Likert-based scale that quantifies robotic surgical proficiency in 5 domains. Given that even highly skilled surgeons can have variability in their skill among their cases, we hypothesized that at a patient level, higher surgical skill as determined by the GEARS score will predict individual patient outcomes.
Methods
Patients undergoing robotic sleeve gastrectomy between July 2018 and January 2021 at a single-health care system were captured in a prospective database. Bivariate Pearson’s correlation was used to compare continuous variables, one-way ANOVA for categorical variables compared with a continuous variable, and chi-square for two categorical variables. Significant variables in the univariable screen were included in a multivariable linear regression model. Two-tailed
p
-value < 0.05 was considered significant.
Results
Of 162 patients included, 9 patients (5.5%) experienced a serious morbidity within 30 days. The average excess weight loss (EWL) was 72 ± 12% at 6 months and 74 ± 15% at 12 months. GEARS score was not significantly correlated with EWL at 6 months (
p
 = 0.349), 12 months (
p
 = 0.468), or serious morbidity (
p
 = 0.848) on unadjusted analysis. After adjusting, total GEARS score was not correlated with serious morbidity (p = 0.914); however, GEARS score did predict EWL at 6 (
p
 < 0.001) and 12 months (
p
 < 0.001). All GEARS subcomponent scores, bimanual dexterity, depth perception, efficiency, force sensitivity, and robotic control were predictive of EWL at 6 months (
p
 < 0.001) and 12 months (
p
 < 0.001) on multivariable analysis.
Conclusion
For patients undergoing sleeve gastrectomy, surgical skill as assessed by the GEARS score was correlated with EWL, suggesting that better performance of a sleeve gastrectomy can result in improved postoperative weight loss.