(149) Association of Global Evaluative Assessment of Robotic Skills (GEARS) Scores with Operative Time for Robotic Hysterectomy: a Retrospective Study

Background: Global Evaluative Assessment of Robotic Skills (GEARS) scores are a validated, crowd-sourced, video-based assessment tool for grading overall technical proficiency for robotic surgery. GEARS scores comprise a composite score from 5 domains, which are judged on Likert scales (1 - 5) – possible overall range from 5 - 25: depth perception, bimanual dexterity, efficiency, force sensitivity, and robotic control.

Objectives: To examine whether GEARS scores are associated with operative time, a common measure of surgical efficiency, for robotic hysterectomy.

Methods: This was a retrospective study of electronic health record data (EHR) from a large U.S. hospital system. Surgeons within the hospital system uploaded videos of robotic hysterectomies for GEARS scoring on a voluntary basis. EHR data for surgeons with ≥4 GEARS-scored robotic hysterectomy uploads between January 1, 2019, and December 30, 2020, were included for analysis; each surgeon was assigned a average GEARS score based on their uploads during this period (baseline average GEARS). Operative times (cut to close) were collected for all robotic hysterectomies performed by these surgeons in 2021. A multivariable generalized linear model (log link, gamma error) was used to examine, for each robotic hysterectomy in 2021, the association of the baseline average GEARS for the operating surgeon with operative time, adjusting for patient and procedural characteristics.

Results: A total of 446 GEARS-scored robotic hysterectomies from 22 surgeons were included for analysis. The mean (min, max) baseline average GEARS score was 20.5 (18.2, 22.9). A total of 938 robotic hysterectomies performed in 2021 were included for the analysis of operative time. The mean (min, max) operative time for robotic hysterectomy was 113.9 (34.0, 440.0). In the multivariable analysis, a 1-point increase in baseline average GEARS was associated with 12% (95% confidence interval [CI] 7% - 16%) lower operative time for robotic hysterectomies performed in 2021. Additional factors that were significantly associated with operative times included increasing age (longer operative time), surgical indication, outpatient surgery (shorter operative time), and increasing number of concomitant secondary procedures (longer operative time).

Conclusions: In this study of robotic hysterectomies, higher average GEARS scores measured over a 2-year baseline period were significantly associated with lower operative times in the following year, suggesting that GEARS scores can meaningfully differentiate surgeons based on this measure of surgical efficiency. Replication of these results in additional surgical procedures or specialties is warranted.