Download PDF
J Wrist Surg 2023; 12(04): 318-323
DOI: 10.1055/s-0042-1757767
Scientific Article

Does Surgeon Level of Expertise Correlate with Patient Outcomes?

Joseph S. Geller‡   *
1   Department of Orthopaedic Surgery, University of Miami, Miami, Florida
,
Lara L. Cohen  ‡   *
2   Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts
,
Dustin H. Massel
1   Department of Orthopaedic Surgery, University of Miami, Miami, Florida
,
Zachary J. Donato
3   University of Miami Miller School of Medicine, Miami, Florida
,
David Chen
1   Department of Orthopaedic Surgery, University of Miami, Miami, Florida
,
Seth D. Dodds
1   Department of Orthopaedic Surgery, University of Miami, Miami, Florida
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Background It is difficult to evaluate the results of surgical techniques as there is inherent variability between surgeons in regard to experience, skill level, and knowledge. Tang suggested a classification system in 2009 in an attempt to standardize surgeon level of expertise, with categories ranging from nonspecialist (Level I) to expert (Level V). This epidemiological analysis of all articles citing Tang's original paper examines if a surgeon's self-reported level of expertise correlates with outcomes and evaluates whether the current definition of Tang level is sufficient to account for expertise bias.

Methods In May 2021, all articles citing Tang level of expertise were identified (N = 222). Articles were included if they described a novel technique and provided author(s)' levels (n = 205). Statistical analysis was conducted, and p-values less than 0.05 were considered significant.

Results The most common specialties reporting Tang level of expertise were orthopaedic surgery (82.9%) and plastic surgery (15.5%). The most common subspecialty was hand surgery. 2020 was the year with the most studies reporting level of expertise (31.7%), followed by 2021 (20.0%) and 2019 (17.1%). The majority of studies (80.5%) reported positive results with their technique, and of these, 63.3% were statistically significant. Level of expertise was not significantly associated with a doctoral degree, type of residency completed, fellowship completion, hand fellowship, author sex, study type, or result significance.

Discussion The current Tang classification is both underreported and incomplete in its present state. To account for expertise bias, we recommend all authors report Tang level when describing surgical techniques. Studies with multiple authors should explicitly state the level of each author, as well as a weighted average accounting for the total contribution of each individual.

Keywords

level of expertise - surgical expertise - hand surgery - plastic surgery - orthopaedic surgery

* Co–first authors who equally contributed to the work.




Publication History

Received: 25 May 2022

Accepted: 05 September 2022

Article published online:
09 November 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Tang JB. Re: Levels of experience of surgeons in clinical studies. J Hand Surg Eur Vol 2009; 34 (01) 137-138
    CrossrefPubMedGoogle Scholar
  • 2 Tang JB, Avanessian B. Clinical reports: the importance of reporting a surgeon's level of expertise. J Hand Surg Am 2015; 40 (02) 416-417
    CrossrefPubMedGoogle Scholar
  • 3 Massel DH, Lezak BA, Summers SH, Yakkanti RR, Hui-Chou HG, Chen DL. Surgeon level of expertise reported in Journal of Hand Surgery (American Volume) and (European Volume) publications. J Hand Surg Eur Vol 2020; 45 (09) 904-908
    CrossrefPubMedGoogle Scholar
  • 4 Nakamura T. Surgeons' level of expertise. J Wrist Surg 2020; 9 (03) 185
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Cohen LLMD, Massel DH, Geller JS, Chen DL, Dodds SD. Expertise of surgeons publishing novel techniques in the Journal of Wrist Surgery . J Wrist Surg 2021; 11 (01) 35-40
    PubMedGoogle Scholar
  • 6 Yakkanti RR, Massel DH, Lezak BA. et al. Surgeon level of expertise in adult reconstruction: a brief communication regarding the need for reporting the level of expertise. Arthroplast Today 2021; 8: 1-4
    CrossrefPubMedGoogle Scholar
  • 7 Duyx B, Urlings MJE, Swaen GMH, Bouter LM, Zeegers MP. Scientific citations favor positive results: a systematic review and meta-analysis. J Clin Epidemiol 2017; 88: 92-101
    CrossrefPubMedGoogle Scholar
  • 8 Hammond JW, Queale WS, Kim TK, McFarland EG. Surgeon experience and clinical and economic outcomes for shoulder arthroplasty. J Bone Joint Surg Am 2003; 85 (12) 2318-2324
    CrossrefPubMedGoogle Scholar
  • 9 Cahill PJ, Pahys JM, Asghar J. et al. The effect of surgeon experience on outcomes of surgery for adolescent idiopathic scoliosis. J Bone Joint Surg Am 2014; 96 (16) 1333-1339
    CrossrefPubMedGoogle Scholar
  • 10 Cahill PJ, Samdani AF, Brusalis CM. et al; Harms Study Group. Youth and experience: the effect of surgeon experience on outcomes in cerebral palsy scoliosis surgery. Spine Deform 2018; 6 (01) 54-59
    CrossrefPubMedGoogle Scholar
  • 11 Jolbäck P, Rolfson O, Mohaddes M. et al. Does surgeon experience affect patient-reported outcomes 1 year after primary total hip arthroplasty?. Acta Orthop 2018; 89 (03) 265-271
    CrossrefPubMedGoogle Scholar
  • 12 Ryan SP, Padilla JA, Schwarzkopf R, Gage MJ, Bolognesi MP, Seyler TM. Arthroplasty surgeons do not improve acute outcomes for patients with hip fracture relative to other subspecialists. Orthopedics 2020; 43 (05) e442-e446
    PubMedGoogle Scholar
  • 13 Malik AT, Jain N, Scharschmidt TJ, Li M, Glassman AH, Khan SN. Does surgeon volume affect outcomes following primary total hip arthroplasty? A systematic review. J Arthroplasty 2018; 33 (10) 3329-3342
    CrossrefPubMedGoogle Scholar
  • 14 Lau RL, Perruccio AV, Gandhi R, Mahomed NN. The role of surgeon volume on patient outcome in total knee arthroplasty: a systematic review of the literature. BMC Musculoskelet Disord 2012; 13: 250
    CrossrefPubMedGoogle Scholar
  • 15 Prystowsky JB, Bordage G, Feinglass JM. Patient outcomes for segmental colon resection according to surgeon's training, certification, and experience. Surgery 2002; 132 (04) 663-670 , discussion 670–672
    CrossrefPubMedGoogle Scholar
  • 16 Archampong D, Borowski D, Wille-Jørgensen P, Iversen LH. Workload and surgeon's specialty for outcome after colorectal cancer surgery. Cochrane Database Syst Rev 2012; (03) CD005391
    PubMedGoogle Scholar
  • 17 Biondo S, Kreisler E, Millan M. et al. Impact of surgical specialization on emergency colorectal surgery outcomes. Arch Surg 2010; 145 (01) 79-86
    CrossrefPubMedGoogle Scholar
  • 18 Pearce WH, Parker MA, Feinglass J, Ujiki M, Manheim LM. The importance of surgeon volume and training in outcomes for vascular surgical procedures. J Vasc Surg 1999; 29 (05) 768-776 , discussion 777–778
    CrossrefPubMedGoogle Scholar
  • 19 Smith CS, Mollon B, Vannabouathong C. et al. An assessment of randomized controlled trial quality in The Journal of Bone & Joint Surgery: update from 2001 to 2013. J Bone Joint Surg Am 2020; 102 (20) e116
    CrossrefPubMedGoogle Scholar
  • 20 Devereaux PJ, Bhandari M, Clarke M. et al. Need for expertise based randomised controlled trials. BMJ 2005; 330 (7482): 88
    CrossrefPubMedGoogle Scholar
  • 21 Rudicel S, Esdaile J. The randomized clinical trial in orthopaedics: obligation or option?. J Bone Joint Surg Am 1985; 67: 1284-1293
    CrossrefPubMedGoogle Scholar