Developing minimally invasive procedure quality metrics: one step at a time

Background: Despite extensive first-hand surgical experience, rank and file members of surgical societies are generally not trained in and have not therefore been included in surgical quality measure development. The purpose of this exercise was to determine if a structured quality metric design tool could bridge this gap, facilitating rapid development of focused quality metrics by minimally invasive surgeon attendees of the April 2018 SAGES Annual Meeting. Methods: Expert minimally invasive surgeons attended a 90-min workshop with didactic and interactive quality metric design sessions during the Annual Meeting. The interactive portion was formed around a novel structured quality measure development tool that graded presenting symptoms, short-term complications, and long-term disutility of care. Results: For first-time symptomatic inguinal hernia repair, first-time small to moderate size ventral hernia repair, and elective laparoscopic cholecystectomy, each workgroup was able to develop one quality, one short-term complication, and one long-term disutility metric. Conclusions: A structured quality metric design tool facilitates application of knowledge through rapid development of multifaceted, patient-centric outcomes measures by expert minimally invasive surgeons, otherwise not formally trained in metric development. The exercise also highlighted the need to rigorously define denominator populations and to guard against metric-driven undertreatment.