mercredi 26 octobre 2011

Fast surgeons = poor results?

It's a swedish study which revealed the data about  hernia repair. I have empirically thought that since a long time... But fast surgeons frequently have the best rating in medias and even in professional institutions and consequently fast surgeons are usually considered as best surgeons. My opinion is that time does not matter so much in today surgery only perfection does... So if time is used to do a perfect procedure it matters at least for hernia repair. My opinion is that it also matters in carotid artery surgery, in coronary artery bypass, in distal leg bypasses...On the other hand the benefit comes with some side effects, complications like infections were more frequent.
"The relative risk of reoperation for recurrence of all patients operated on in less than 36 minutes was 26% higher than that of all patients with an operating time of more than 66 minutes (1.26; 95% CI, 1.11-1.43). Because the Lichtenstein procedure is the standard procedure in Sweden today, its results were also analyzed separately. In this homogeneous group, the difference was even more striking with an increased relative risk of 45% (1.45; 95% CI, 1.21-1.75). The odds ratio for infection and other postoperative complications increased with increasing operating time."

"In hernia surgery, therefore, careful, time-consuming repair may pay off," they write.
To date, "[t]he general impression seems to be that speed reflects skill, which in turn stems from experience gained by large volume, whereas prolonged operations are assumed to signify inexperience or trouble," write the study authors. "By contrast, in the present series, the presumed skill gained by volume manifested itself in speed but did not show up in outcome."

National Register Study of Operating Time and Outcome in Hernia Repair
Willem van der Linden, MD, PhD; Anna Warg, MD; Pär Nordin, MD, PhD

Arch Surg. 2011;146(10):1198-1203. doi:10.1001/archsurg.2011.268