Alexandra M Moore1, Justin P Wagner1, Vivek Agrawal2, Charles J Filipi3, David C Chen1. 1David Geffen School of Medicine at UCLA, 2Comment Bubble, Inc., 3CHI Health
OBJECTIVE: Inguinal hernias represent a significant burden of surgically-treatable disease around the world. It has previously been shown that using web-based tools for long-term and remote surgical proctorship is feasible to expand capacity in underserved communities worldwide. In this study, we present a web interface for video assessments of operative performance to improve access to global surgical proctorship.
METHODS: This study took place between October 2014 and October 2015. Participants included 13 surgeons from Brazil, Dominican Republic, Haiti, and Paraguay who underwent a formal training program in Lichtenstein hernioplasty. At 6 months after training, surgeons were instructed to upload point-of-view videos of independent hernioplasties to a secure video hosting website. The Operative Performance Rating Scale (OPRS) was adapted to a web platform (Surgus) for video-based technical performance reviews. Independent video reviews were performed by 3 US surgeon trainers using the Surgus platform. Participating surgeons received individual performance summaries via a custom Surgus web portal. Variation among raters was normalized by deriving the standard deviation of scores assigned to each surgeon for each OPRS metric. Variance in normalized standard deviations was calculated across all surgeons for each metric.
RESULTS: All 13 surgeons submitted a total of 14 Lichtenstein hernioplasty videos 6 months after the conclusion of formal training. All videos were uploaded and subject to the Surgus OPRS platform. OPRS reviews were conducted successfully, with an average overall score of 3.9 ± 0.9 demonstrating technical proficiency that corresponds with an OPRS descriptor of “Very Good” performance. Observed variance and maximum variance of OPRS ratings among the 3 reviewers are shown (Table 1).
TABLE 1
| Rating Category | Variance | Maximum |
Operation-specific metrics | ||
| Incision | 0.17 | 5.29 |
| Dissection | 0.29 | 5.29 |
| Preparation for Mesh Placement | 0.26 | 5.29 |
| Mesh Cutting | 0.28 | 5.29 |
| Mesh Fixation | 0.43 | 5.29 |
| Closure | 0.45 | 5.29 |
General performance metrics | ||
| Case Difficulty | 0.08 | 1.32 |
| Degree of Prompting | 0.16 | 1.32 |
| Instrument Handling | 0.16 | 5.29 |
| Respect for Tissue | 0.17 | 5.29 |
| Time and Motion | 0.37 | 5.29 |
| Operation Flow | 0.20 | 5.29 |
| Overall Performance | 0.37 | 5.29 |
CONCLUSIONS: Our web-based performance evaluation system provides a means of reliable remote technical assessments from recorded video internationally with relatively low variance among reviewers. The Surgus platform has demonstrated utility for international surgical proctorship. This study invites further evaluations of surgeon performance and patient outcomes for a variety of operations to establish global standards of surgical care.