Surgical skill and complication rates after bariatric surgery.

To the Editor: Birkmeyer et al. (Oct. 10 issue)1 report that peer ratings of the technical skill of bariatric surgeons correlated with patient outcomes as measured according to complication rates — the higher the peer rating of technical skill, the lower the rate of complications. This finding may be true for laparoscopic bypass surgery performed by bariatric surgeons, but it may not hold true for other types of surgery. The study involved an operative procedure in which the technique is fairly standard. To suggest that the same findings may be observed in other procedures in which surgical approaches, techniques, and instruments vary significantly2,3 would be preliminary. Furthermore, although the authors use the term “surgeon,” there are considerable differences in the technical aspects of various surgical subspecialties.2 In rapidly advancing fields such as neurosurgery in which operative techniques are constantly changing,2,3 it is unclear whether peer ratings of technical skill are feasible, since variations in surgical technique are so diverse.