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Original Investigation
June 14, 2017

Surgeon Variation in Complications With Minimally Invasive and Open ColectomyResults From the Michigan Surgical Quality Collaborative

Author Affiliations
  • 1Department of Surgery, University of Michigan, Ann Arbor
  • 2Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor
  • 3Michigan Surgical Quality Collaborative, University of Michigan, Ann Arbor
JAMA Surg. Published online June 14, 2017. doi:10.1001/jamasurg.2017.1527
Key Points

Question  How do rates of complications and surgeon ranking compare for minimally invasive colectomy vs open colectomy among surgeons?

Findings  In this cohort study of 97 surgeons and 5196 patients, rates of complications varied nearly twice as much among surgeons for minimally invasive colectomy compared with open colectomy.

Meaning  The study findings imply a need for improved training in adoption of minimally invasive colectomy techniques among some surgeons.


Importance  Minimally invasive colectomy (MIC) is an increasingly common surgical procedure. Although case series and controlled prospective trials have found the procedure to be safe, it is unclear whether safe adaptation of this approach from open colectomy (OC) is occurring among surgeons.

Objective  To assess rates of complications for MIC compared with OC among surgeons.

Design, Setting, and Participants  We analyzed 5196 patients who underwent MIC or OC from January 1, 2012, through December 31, 2015, by 97 surgeons in the Michigan Surgical Quality Collaborative, with each surgeon performing at least 10 OCs and 10 MICs. Hierarchical regression was used to assess surgeon variation in adjusted rates of complications and the association of these outcomes across approaches.

Main Outcomes and Measures  Primary study outcome measurements included overall 30-day complication rates, variation in complication rates among surgeons, and surgeon rank by complication rate for MIC vs OC.

Results  Of the 5196 patients (mean [SD] age, 62.9 [14.4] years; 2842 [54.7%] female; 4429 [85.2%] white), 3118 (60.0%) underwent MIC and 2078 (40.0%) underwent OC. Overall, 1149 patients (22.1%) experienced complications (702 [33.8%] in the OC group vs 447 [14.3%] in the MIC group; P < .001). For MIC, the rates of complications varied from 8.8% to 25.9% among surgeons. For OC, rates of complications were higher but varied less (1.7-fold) among surgeons, ranging from 25.9% to 43.8%. Among the 97 surgeons ranked, the mean change in ranking between OC and MIC was 25 positions. The top 10 surgeons ranged in rank from 6 of 97 for OC to 89 of 97 for MIC.

Conclusions and Relevance  Surgeon-level variation in complications was nearly twice as great for MIC than for OC among surgeons enrolled in a statewide quality collaborative. Moreover, surgeon rankings for OC outcomes differed substantially from outcomes for those same surgeons performing MIC. This finding implies a need for improved training in adoption of MIC techniques among some surgeons.