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Involvement of a skill-qualified surgeon favorably influences outcomes of laparoscopic cholecystectomy performed for acute cholecystitis

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Abstract

Objective

The Endoscopic Surgical Skill Qualification System (ESSQS) was developed by the Japan Society for Endoscopic Surgery as a means of subjectively assessing the proficiency of laparoscopic surgeons. We conducted a study to evaluate how involvement of an ESSQS skill-qualified (SQ) surgeon influences short-term outcomes of laparoscopic cholecystectomy performed for acute cholecystitis.

Summary of background data

Previous reports suggest that assessment of the video-rating system is a potential tool to discriminate laparoscopic surgeons’ proficiency and top-rated surgeons face less surgical mortality and morbidity in bariatric surgery.

Methods

Data from the National Clinical Database regarding laparoscopic cholecystectomy performed for acute cholecystitis between January 2016 and December 2018 were analyzed. Outcomes were compared between patients grouped according to involvement vs. non-involvement of an SQ surgeon. Outcomes were also compared between patients grouped according to whether their operation was performed by biliary tract-, stomach-, or colon-qualified surgeon.

Results

Of the 309,998 laparoscopic cholecystectomies during the study period, 65,295 were suitable for inclusion in the study and 13,670 (20.9%) were performed by an SQ surgeon. Patients’ clinical characteristics did not differ between groups. Thirty-day mortality was significantly lower in the SQ group (0.1%) 16/13,670 than in the non-SQ group (0.2%) 140/51,625 (P = 0.001). Thirty-day mortality was [0.1% (9/7173)] in the biliary tract-qualified group, [0.2% (5/3527)] in the stomach-qualified group, and [0.1% (2/3240)] in the colon-qualified group.

Conclusion

Surgeons with ESSQS certification outperform the non-skilled surgeons in terms of surgical mortality in 30 and 90 days. Further verification of the value of the ESSQS is warranted and similar systems may be needed in countries across the world to ensure patient safety and control the quality of surgical treatments.

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Abbreviations

JSES:

Japan Society for Endoscopic Surgery

ESSQS:

Endoscopic Surgical Skill Qualification System

SQ:

Skill-qualified

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Acknowledgements

This study was supported by the Japan Society for Endoscopic Surgery.

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Authors and Affiliations

  1. Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, Tokyo, 181-8611, Japan

    Toshiyuki Mori & Yoshihiro Sakamoto

  2. Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Hideki Endo

  3. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan

    Takeyuki Misawa

  4. Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan

    Shigeki Yamaguchi

  5. Gastroenterological and Pediatric Surgery, Oita University of Faculty of Medicine, Yufu, Oita, Japan

    Masafumi Inomata

  6. Department of Surgery, Red Cross Hospital Osaka, Osaka, Japan

    Yoshiharu Sakai

  7. Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Yoshihiro Kakeji

  8. Department of Health Policy and Management, Keio University, Tokyo, Japan

    Hiroaki Miyata

  9. Department of Surgery, Keio University School of Medicine, Tokyo, Japan

    Yuko Kitagawa

  10. Kitasato University, Kitasato Institute Hospital, Tokyo, Japan

    Masahiko Watanabe

Authors
  1. Toshiyuki Mori
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  2. Hideki Endo
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  9. Hiroaki Miyata
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  10. Yuko Kitagawa
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  11. Masahiko Watanabe
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Corresponding author

Correspondence to Toshiyuki Mori.

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Disclosures

Drs. Toshiyuki Mori, Hideki Endo, Takeyuki Misawa, Shigeki Yamaguchi, Yoshihiro Sakamoto, Masafumi Inomata, Yoshiharu Sakai, Yoshihiro Kakeji, Hiroaki Miyata, Yuko Kitagawa, and Masahiko Watanabe have no conflict of interest or financial ties to disclose.

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Mori, T., Endo, H., Misawa, T. et al. Involvement of a skill-qualified surgeon favorably influences outcomes of laparoscopic cholecystectomy performed for acute cholecystitis. Surg Endosc 36, 5956–5963 (2022). https://doi.org/10.1007/s00464-022-09045-9

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