The Impact of Feedback of Surgical Outcome Data on Surgical Performance: A Systematic Review
Increasing patient demands, costs and emphasis on safety have led to performance tracking of individual surgeons. Several methods of using these data, including feedback have been proposed. Our aim was to systematically review the impact of feedback of outcome data to surgeons on their performance.
MEDLINE, Embase, PsycINFO, AMED and the Cochrane Database of Systematic Reviews (from their inception to February 2013) were searched. Two reviewers independently reviewed citations using predetermined inclusion and exclusion criteria. Forty two data-points per study were extracted.
The search strategy yielded 1,531 citations. Seven studies were eligible comprising 18,632 cases or procedures by 52 surgeons. Overall, feedback was found to be a powerful method for improving surgical outcomes or indicators of surgical performance, including reductions in hospital mortality after CABG of 24 % (P = 0.001), decreases of stroke and mortality following carotid endarterectomy from 5.2 to 2.3 %, improved ovarian cancer resection from 77 to 85 % (P = 0.157) and reductions in wound infection rates from 14 to 10.3 %. Improvements in performance occurred in concert with reduced costs: for hepaticojejunostomy, implementation of feedback was associated with a decrease in overall hospital costs from $24,446 to $20,240 (P < 0.01). Similarly, total cost of carotid endarterectomy and following management decreased from $13,344 to $9548.
The available literature suggests that feedback can improve surgical performance and outcomes; however, given the heterogeneity and limited number of studies, in addition to their non-randomised nature, it is difficult to draw clear conclusions from the literature with regard to the efficacy of feedback and the specific nuances required to optimise the impact of feedback. There is a clear need for more rigorous studies to determine how feedback of outcome data may impact performance, and whether this low-cost intervention has potential to benefit surgical practice.
- 4.Cleveland Clinic. Treatment Outcomes 2011 (http://my.clevelandclinic.org/heart/about-heart-vascular-institute/treatment-outcomes.aspx)
- 5.Shahian DM, Jacobs JP, Edwards FH, Brennan JM, Dokholyan RS, Prager RL et al (2013) The society of thoracic surgeons national database. Heart 99:1494–1501. http://www.ncbi.nlm.nih.gov/pubmed/23335498
- 7.Royal College of Surgeons of England. RCS hails landmark publication of individual surgeons’ outcomes data. 2013 (https://www.rcseng.ac.uk/news/rcs-hails-landmark-publication-of-individual-surgeons2019-outcomes-data#.U-UoVRaOdss)
- 8.Khuri SF, Daley J, Henderson W, Hur K, Demakis J, Aust JB, Chong V, Fabri PJ, Gibbs JO, Grover F, Hammermeister K, Irvin G 3rd, McDonald G, Passaro E Jr, Phillips L, Scamman F, Spencer J, Stremple Jf (1998) The Department of Veterans Affairs’ NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg 228(4):491–507CrossRefPubMedCentralPubMedGoogle Scholar
- 14.O’Connor GT, Plume SK, Olmstead EM, Morton JR, Maloney CT, Nugent WC et al (1996) A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery. The Northern New England Cardiovascular Disease Study Group. JAMA 275(11):841–846CrossRefPubMedGoogle Scholar
- 25.Forsetlund L, Bjorndal A, Rashidian A, Jamtvedt G, O’Brien MA, Wolf F, et al. (2009) Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev (2):CD003030Google Scholar