Taking Surgical Quality Improvement to the Next Level

Taking Quality Improvement to the Next Level

There will always be some degree of variability in surgical practice. Every procedure and surgeon has unique characteristics that make this inevitable. However, there are many circumstances in which surgical variability is a red flag that there is room for improvement. If Surgeon A is taking twice as long to complete the same procedure as Surgeon B, this is likely to affect quality of care and surgical outcomes, and interventions to address this discrepancy could improve these parameters.


Luckily, equipping your OR with Theator’s Surgical Intelligence Platform offers a simple and  transformative solution to this complex issue. Only Theator’s state-of-the-art platform provides  the comprehensive tools needed to identify surgical variability, connect this information to surgical outcomes, and offer custom solutions to improve practice and standardize care.


Are you wondering how we do it? Here’s what our technology offers that you won’t find anywhere else.

Intraoperative Intelligence

Theator’s technology begins recording procedures automatically, eliminating the possibility of human error resulting in missed recordings. Once a procedure begins, real-time feedback and updates are instantly available to those in the OR and other key team members, such as attending physicians and charge nurses. This means faster reaction times when unplanned events occur and increased OR efficiency as staff are kept informed of case progression.


Because Theator’s platform can identify procedural steps as they occur, recorded cases are tagged by key moments, making them easy to review for educational and quality improvement purposes. In addition, our technology is compatible with any device, so you have multiple options for watching and reviewing cases from the hospital or on the go. 

EHR Integration

Identification of intraoperative steps is an excellent first step toward reducing surgical variability. However, without connecting surgical events to patient outcomes it’s impossible to know if practice changes are truly moving the needle on quality of care.

That’s why our platform seamlessly integrates with your EHR system. By automatically connecting surgical events to patient outcomes, our technology can identify disparate outcomes related to surgical variability and easily track changes over time as improvement efforts are implemented.

AI-Powered Analytics

It goes without saying that taking the time to manually review recorded surgical video and connect intraoperative events with patient outcomes would be impossible for any surgeon. That’s where AI tools provide the support needed to harness and analyze the vast volume of data in recorded procedures to generate customized and meaningful insights for individual and systemic improvement.

Our dashboard offers each surgeon analytics about their individual cases and patient outcomes and how their results compare to their peers. By providing granular information about surgical variability, surgeons can then use these insights to adjust their practice and follow changes in their outcomes over time.

Choose Surgical Intelligence That Meets Your Needs

Other surgical AI platforms promise recorded video that will improve surgical care. However, this usually comes with a catch. These other platforms often don’t integrate with all the hardware and software you already have in your OR, don’t connect with your EHR to link surgical events to patient outcomes, or don’t have advanced AI tools to analyze data and offer personalized recommendations for improvement. When it comes to updating your OR to best meet the needs of surgeons and patients, be sure to choose a surgical intelligence platform that checks all these boxes so you can improve quality and optimize patient outcomes instead of just gathering data.

Ready to adopt surgical intelligence in your operating rooms? Make sure to use our AI evaluation checklist when evaluating different technologies. Get the checklist here.

Three steps for hospitals and surgical teams to start reducing surgical variability today

What can hospitals and surgical teams start doing right now to reduce surgical variability?

Short answer – not a lot, at least not a lot without the help of technology.

Hospitals are grappling with variability in surgical outcomes, yet the ground truth, aka surgical video, is not routinely captured. And even if it is captured, surgeons are busy, and don’t have time to analyze all of that raw video data.

So what steps can hospital executives, administrators, and surgical teams start taking now to tackle surgical variability and all of its damaging effects?

Step one: Capture better data

Especially for minimally invasive procedures (both laparoscopic and robotic), where surgery is visually guided and therefore a camera is already there. Simply fostering a “culture of capture” for every procedure, whenever possible.

Automating capture is key to success:​

As creatures of habit, changing institutional culture and habits can be a difficult task. At Theator, we’ve seen this first hand – this is why our Surgical Intelligence Platform doesn’t have a record button, it starts recording automatically.

Before implementing our automatic recording feature we were shocked to see the number of videos that weren’t being recorded. Even though the benefits were clear, and the technology was readily available to surgeons in the operation room. It became clear that automating this function was key to fostering a culture of capture. 

Step two: Mine recorded surgical data

Once hospitals have created a ‘culture of capture’ they can mine the surgical footage to surface where variability exists intraoperatively to identify opportunities for improvement. This will make it possible to set specific goals and monitor adoption to programs put in place to achieve them. This entails reviewing, annotating or structuring the data, and compiling data points to make analysis possible.

Step three: Take advantage of new tech solutions

Hospitals must take advantage of new tech solutions to help. Sifting through all that surgical video manually can be extremely time consuming and resource-intensive, but there are platforms available now that can do it all for you — and connect the data to patient outcomes.

The ability to connect what happens intraoperatively to a patient’s recovery postoperatively, generates hospital- and surgeon-specific insights on how to improve the quality of surgical care.  

Ready to start reducing variability?

Download our Beginners Guide to Surgical Variability eBook:


Surgical Variability’s Impact on The Entire Healthcare Ecosystem

The impacts of surgical variability extends far beyond individual procedures

Simply put, “surgical variability” means not all surgeons perform surgery exactly the same way. Because of the many factors contributing to variability between procedures, reducing variability is a challenge hospital administrators are painfully aware of. Some causations are obvious, like patient factors or healthcare inequity. While others are more opaque—like subjective experiences between surgeons, or a lack of actionable data

The effects of surgical variability at every level of the healthcare ecosystem are significant and wide-ranging. It’s no wonder that executives, administrators, and surgical teams have long been in search of reliable ways to reduce or eliminate it altogether.

Variability in surgical care often leads to preventable complications and poor outcomes, but patients are not the only ones feeling the negative impacts of surgical variability…

To patients surgical variability can mean life or death

Obviously the group hardest hit by disparities in surgical care is patients. The worst case scenario for them, of course, is preventable death. But even unforeseen complications resulting in longer hospital stays, additional health issues, or the need for reoperation can take a massive toll. Patients miss work, incur huge hospital bills, have their lives interrupted, endure pain, discomfort, and lack of privacy, and often suffer psychological distress due to these experiences.

The burden of variability also weighs heavy on caregivers & loved ones

Those closest to the patient experience the ripple effects of the events described above. From managing and coping with the death of their loved one to providing assistance that also disrupts their daily lives and drains them of time, money, energy, and mental health, entire communities feel the impact of surgical variability.

The psychological impact of variability on surgeons

Generally speaking, surgeons and surgical staff strive to continuously hone their craft and deliver the best possible outcomes for their patients. But pervasive variability in processes and techniques (and especially the visibility issues that cause that problem) limits their ability to develop professionally — and to help others improve. The resulting complications and negative outcomes also take a psychological toll on them.

The financial, operational, and liability implications of variability on hospitals

The financial and operational impact on individual hospitals is tremendous. Estimated costs incurred due to gastric leak in laparoscopic sleeve gastrectomy are up to $10,000 per incident — and that’s just one complication that occurs in one type of procedure in one specialty. Hospitals also have to contend with liability issues, such as malpractice suits, insurance reimbursement, and more. And operationally speaking, even what may seem like minor efficiency issues, when replicated across thousands of procedures per year, can add up in terms of budget, resources, and patient care. In a system already stretched too thin, these institutions can ill afford the effects of surgical variability.

Health systems carry the consequences of variability at scale

Similar to how the impact on patients ripples outward to their communities, the impact on hospitals ripples throughout health systems, eating up precious resources that could be used to improve care. No one can “afford” to fix the problem, but the problem itself is costing an ever-growing fortune.

Surgical Variability: A problem we can’t afford to ignore.

Surgical variability has significant implications on the entire healthcare ecosystem, it’s clear that this is an issue we cannot afford to ignore. Though it’s unlikely that we can eliminate this issue entirely, there are steps we can take today to reduce avoidable procedural variability by driving standardization in adoption to evidence-based, surgical best practices. Only by capturing, structuring, and analyzing surgical data, we can surface intraoperative variability that impacts postoperative recovery and start to solve variability one department at a time. 

Ready to start reducing variability?

Download our Beginners Guide to Surgical Variability eBook:

The Role of Surgical Variability in Complication Prevention

The Frequency of Surgical Complications is Alarmingly High

From the earliest days of trepanation to modern minimally invasive techniques, we’ve come a long way in the field of surgery. But we’re still far from perfect. In fact, of the 300 million surgical procedures performed annually, nearly 1 in 6 still involve complications, resulting in around 3 million deaths per year. The subsequent physical, emotional, and psychological effects on patients and their loved ones, as well as the massive financial and operational impact on hospitals and surgical teams, are impossible to overstate.

The Role of Surgical Variability in Complication Prevention

Variability in surgical care contributes to this high incidence of preventable complications and poor outcomes,  and stems from a lack of adoption to data-driven surgical practices. And disparities aren’t limited to less-developed regions. We see variability between hospitals — and even departments — in major metropolitan centers of the most developed countries on Earth.

Administrators are painfully aware of this challenge, but have struggled to find any reliable way of solving it. Many hospitals invest heavily in hiring teams to analyze their own data and/or to participate in The American College of Surgeons National Surgical Quality Improvement Program (NSQIP). While the program is designed to measure and improve the quality of surgical care, participation does little more than confirm variability exists and show how participants measure up against their peer hospital groups. 

You don’t need sample data that’s delayed 6 months (and isn’t actionable) to tell you any of that. You need better ways to understand why this surgical variability exists in the first place, pinpoint specific areas of improvement, set goals, and achieve them. But let’s start with surgical variability: its causes, effects — and what hospitals and surgical teams can start doing about it now.

What causes surgical variability?

In its most literal sense, “surgical variability” means “not all surgeons perform surgery exactly the same way.” When we break down any procedure into its component steps (assuming even these are standardized), there are any number of different circumstances that could arise, techniques that could be employed, or processes that could be followed during each step that influences the outcome. 

For example, during a laparoscopic sleeve gastrectomy, oversewing the staple line has been shown to help prevent gastric leak and bleeding — two of the most serious complications of this common procedure. Yet a recent analysis of 370 sleeve gastrectomies revealed this technique was performed in only 60% of cases.*

The same analysis also revealed significant variability in surgical efficiency, with average time to perform a specific step, the gastric transection, as low as 13 minutes and 20 seconds for some surgeons, and nearly 39 minutes for others. Considering that longer procedure times are associated with poorer patient outcomes and higher hospital costs, this is no small matter.

While all these opportunities for deviation might seem to create an infinite number of un-trackable variations, there are some common threads that can help us make sense of it all:

  1. Healthcare inequity. Unfortunately, socioeconomic factors, inherent bias, and other equality-based considerations often cause disparities in care and outcomes. From limited access to even basic care (let alone advanced technologies) to communication and trust issues, myriad factors put a disproportionate share of the negative effects of surgical variability on historically marginalized populations.
  2. Patient factors. Every patient is different. Some have pre-existing conditions that put them at higher risk during certain procedures or specific techniques. Some have anatomical anomalies that require in-the-moment adjustments or deviations from standard practices. But particularly with common procedures that are performed thousands of times every day across the world, we should be able to account for these factors by now with documented surgical practices.
  3. Subjective experience. Due to the age-old apprenticeship model of surgical training, one surgeon’s career-long experience can be dramatically different from another’s without either ever realizing it. When your training and daily practice are so heavily guided by the subjective experience of one person (who learned many of the same things, the same way, from yet another single person, and so on), your perspective is inherently narrow and biased.
  4. Lack of actionable data. Although many aspects of surgery are tracked and reported, surgical teams often suffer from “DRIP” (data-rich, insight-poor) visibility issues. Sometimes there’s a scarcity of proof to back up new or emerging recommendations, making surgeons more hesitant to adopt them. And sometimes the data that could be most helpful is simply not reliable or accessible. For example, the best record most hospitals currently have of what goes on in the OR is the surgeon’s operative report. These are typically templatized, created after the fact, and (as has been widely reported) often highly inaccurate. In fact, one paper, entitled A Video is Worth a Thousand Operative Notes revealed that while operative reports claimed 85.1% of technical steps were followed, operative video confirmed only 52.5% actually had been.

Surgical Intelligence: The Next Step to Reducing Variability

Because of these factors, completely eliminating surgical variability may not be possible. But we have the resources to start reducing variability by a significant margin. Powered by AI and machine learning, Surgical Intelligence can help us connect the dots between patient characteristics, surgical practices, and post-op results. Because it’s understanding surgical outcomes is not enough, we have to understand how specific decisions and practices impact those outcomes. 


*References: Theator Surgical Intelligence Platform Data on File: Bariatric Procedure Analysis, 2023.

Dobson GP. Trauma of major surgery: A global problem that is not going away. Int J Surg. 2020 Sep;81:47-54. doi: 10.1016/j.ijsu.2020.07.017. Epub 2020 Jul 29. PMID: 32738546; PMCID: PMC7388795.

Ready to start reducing variability?

Download our Beginners Guide to Surgical Variability eBook:


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