Technical skills and outcomes assessment in endoscopic sinus surgery: Surgical competency matters

Surgical competency is traditionally cosidered as an ability to perform surgery successfully. However, patient outcomes do not depend only on the surgical skills of a surgeon which calls for the revision of the concept of surgical competency. Surgical competency is a combination of skills which allow the surgeon to successfully apply his knowledge and skills to undertstand and make necessary changes according to the needs and circumstances of an indivdual patient to solve the clinical problem. Accordingly, the assessment of competency depends on various factors; however, patient outcomes are the ultimate result of the surgeons' performance. Patient outcomes can be measured in terms of mortality, morbidity, resolution of patient's symptoms, length of stay, complication rates, functional status, quality of life, satisfaction with treatment results, readmission rates and healthcare costs. As every surgical specialty is different with wide range of procedures, the skills that determine the successful outcome depend primarily on the type of procedure itself. Endoscopic sinus surgery (ESS) is a procedure which truly reflects the concept of surgical competency. The successful outcome of ESS requires competency in surgical skills along with an understanding of the disease process, treatment strategies and comorbidities.