Technical and Nontechnical Skills in Surgery

Study Design. Observational simulation study. Objective. The goal of this study was to investigate the relationship between technical and nontechnical skills (NTS) in a simulated surgical procedure. Summary of Background Data. Although surgeons' technical and NTS during surgery are crucial determinants for clinical outcomes, little literature is available in spine surgery. Moreover, evidence regarding how surgeons' technical and NTS are related is limited. Methods. A mixed-reality and full-scale simulated operating room environment was employed for the surgical team. Eleven surgeons performed the vertebroplasty procedure (VP). Technical skills (TS) were assessed using Objective Structured Assessment of Technical Skill scores and senior expert-evaluated VP outcome assessment. NTS were assessed with the Observational Teamwork Assessment for Surgery. Kendall-Tau-b tests were performed for correlations. We further controlled the influence of surgeons' experience (based on professional tenure and number of previous VPs performed). Result. Surgeons' NTS correlated significantly with their technical performance (tau = 0.63; P = 0.006) and surgical outcome scores (tau = 0.60; P = 0.007). This association was attenuated when controlling for surgeons' experience. Conclusion. Our results suggest that spine surgeons with higher levels of TS also apply better communication, leadership, and coordination behaviors during the procedure. Yet, the role of surgeons' experience needs further investigation for improving surgeons' intraoperative performance during spine surgery.