Surgical Sabermetrics: A Scoping Review of Technology-Enhanced Assessment of Non-Technical Skills in the Operating Room.

OBJECTIVE: To evaluate the current evidence for surgical sabermetrics: digital methods of assessing surgical non-technical skills and investigate the implications for enhancing surgical performance.

BACKGROUND: Surgeons need high-quality, objective, and timely feedback to optimise performance and patient safety. Digital tools to assess non-technical skills have potential to reduce human bias and aid scalability. However, we do not fully understand which of the myriad of digital metrics of performance assessment have efficacy for surgeons.

METHODS: A systematic review was conducted by searching PubMed, EMBASE, CINAHL, and PSYCINFO databases following PRISMA-ScR guidelines. MeSH terms and keywords included "Assessment" "Surgeons" and "Technology". Eligible studies included digital assessment of non-technical skills for surgeons, residents, and/or medical students within an operative context.

RESULTS: From 19,229 articles screened, 81 articles met inclusion criteria. The studies varied in surgical specialities, settings, and outcome measurements. A total of 122 distinct objective, digital metrics were utilized. Studies digitally measured at least one category of surgical non-technical skill using single(n=54) or multiple objective measures(n=27). The majority of studies utilised simulation(n=48) over live operative settings (n=32). Surgical Sabermetrics has been demonstrated to be beneficial in measuring cognitive load(n=57), situation awareness(n=24), communication(n=3), teamwork(n=13), and leadership(n=2). No studies measured intraoperative decision-making.

CONCLUSIONS: The literature detailing the intersection between surgical data science and operative non-technical skills is diverse and growing rapidly. Surgical Sabermetrics may provide a promising modifiable technique to achieve desirable outcomes for both the surgeon and the patient. This study identifies a diverse array of measurements possible with sensor devices and highlights research gaps, including need for objective assessment of decision-making. Future studies may advance the integration of physiological sensors to provide holistic assessment of surgical performance.