AB186. SOH25_AB_223. Measuring surgical performance: a systematic review of current methods and their impact on outcomes

Background: Surgical competence and proficiency have been shown to correlate with postoperative outcomes, but there is little standardisation in how performance is assessed. This systematic review aims to identify the current best methods used to assess performance in surgery as related to the effect it has on surgical outcomes.

Methods: A systematic literature review was conducted using the EMBASE, Scopus, PubMed, and CINAHL databases. A total of 339 studies were identified, and 117 were selected for full-text review, of which 18 met the inclusion criteria. Automated performance metrics (APMs), objective structured assessments of technical skills (OSATS), global evaluative assessment of robotic skills (GEARS) and procedure-specific scoring systems were identified as metrics used to assess performance and correlate with outcomes.

Results: Increasing OSATs and procedure-specific objective assessment forms are associated with improved outcomes and reduced complications; however, they show some variance between raters. GEARS scores have been shown to correlate with improved outcomes and correlate with APMs and can be assessed by non-expert assessors with good reliability. APMs are predictive of surgical experience and can produce near-instant modelling of possible complications with machine learning.

Conclusions: Observed semi-objective assessments, such as OSATs, remain the cornerstone of performance evaluation but require significant human resources. Emerging technologies, including APMs and machine learning-based analysis of video feed, offer promising, scalable alternatives that correlate with established methods.

Keywords: Assessments of technical skills; effect of performance on outcomes; emerging technology in skill assessment; standardisation of surgical assessment; surgical performance metrics