Assessing Wire Navigation Performance in the Operating Room

OBJECTIVE: There are no widely accepted,objective, and reliable tools for measuring surgical skill in the operating room (OR). Ubiquitous video and imaging technology provide opportunities to develop metrics that meet this need. Hip fracture surgery is a promising area in which to develop these measures because hip fractures are common, the surgery is used as a milestone for residents, and it demands technical skill. The study objective is to develop meaningful, objective measures of wire navigation performance in the OR. DESIGN: Resident surgeons wore a head-mounted video camera while performing surgical open reduction and internal fixation using a dynamic hip screw. Data collected from video included: duration of wire navigation, number of fluoroscopic images, and the degree of intervention by the surgeon's supervisor. To determine reliability of these measurements, 4 independent raters performed them for 2 cases. Raters independently measured the tip-apex distance (TAD), which reflects the accuracy of the surgical placement of the wire, on all the 7 cases. SETTING: University of Iowa Hospitals and Clinics in Iowa City, IA-a public tertiary academic center. PARTICIPANTS: In total 7 surgeries were performed by 7 different orthopedic residents. All 10 raters were biomedical engineering graduate students. RESULTS: The standard deviations for anteroposterior, lateral, and combined TAD measurements of the 10 raters were 2.7, 1.9, and 3.7 mm, respectively, and interrater reliability produced a Cronbach alpha of 0.97. The interrater reliability analysis for all 9 video-based measures produced a Cronbach a of 0.99. CONCLUSIONS: Several video-based metrics were consistent across the 4 video reviewers and are likely to be useful for performance assessment. The TAD measurement was less reliable than previous reports have suggested, but remains a valuable metric of performance. Nonexperts can reliably measure these values and they offer an objective assessment of OR performance. (C) 2016 Published by Elsevier Inc. on behalf of the Association of Program Directors in Surgery