Proposing A Mathematical Equation For Surgical Outcomes

Stephen Barrett DPM FACFAS

I recently read a great book called Super Crunchers, which illustrates the power of information technology. The book was written by Ian Ayres, an econometrician and professor at Yale Law School. He notes that from the analysis of huge amounts of data, really cool stuff can happen. One can make predictions that outperform the knowledge of “experts.” These predictions range from what is going to be a great Bordeaux red to what Hollywood films are going to break the box office records. That data, and lots of it, can now be formulated into mathematical equations, which turn out to be more accurate than our deified experts.

How can this be? Who could ever think that a guy who charts rainfall and temperatures could outdo a wine expert like Robert Parker? Professor Ayers has inspired me, a non-mathematician, to postulate the Ultimate Podiatric Surgical Equation (UPSE):

Surgical Outcome = ∑[(AD + PE) * (SCλ +POM)]*Pt.E

First, let me preface this by saying there is no evidence-based medicine or true mathematical relationship that can quantify a patient outcome. Each situation is highly variable and to really quantify the ultimate surgical experience is incalculable.

However, after more than two decades of performing simple to complex podiatric surgical procedures, clinical experience and observation have led to the development of the aforementioned mathematical formula that I propose. I may change the equation next month but can’t mathematicians change their equations as frequently as most of us change channels? Really, why are there such different outcomes between different surgeons for the same procedure, even when then they had equivalent didactic and surgical training? Certainly, it has to come down to multiple variables and a delicate and intricate relationship between them.

The aforementioned formula simply represents an ideation that the ultimate surgical outcome, regardless of the procedure in question, is dependent upon many, many variables. Some of these variables are poorly controlled prior to surgeons performing the surgery. This ultimately leads to a less than desirable surgical outcome even though the surgery itself went well and sometimes all the variables are executed perfectly. However, the surgeon may not have completely addressed one variable, which can blow the whole outcome apart. Here are the variables:

1. AD= accurate diagnosis
2. PE= patient education
3. SCλ=surgical competence times lambda, which is a coefficient of experience and training
4. POM= postoperative management
5. Pt.E= patient expectations

This month’s blog is going to deal with item 3 or variable SCλ. We all know surgical competence requires constant education and training, which is why we are all forced to attend so many lame CME meetings. How many more variations of the “Austin,” I mean “Chevron,” no I mean “Austin Powers Chevron” osteotomy, must we be subjected to? That is a whole other discussion but in this blog, I want to focus on a society that has a different focus. While this society is small and has a specialized focus, I believe it will have a great impact on the future care of patients.

Multiply Your Experience And Training With The Peripheral Nerve

The Association of Extremity Nerve Surgeons (AENS) now has 105 members. This is a really good group of dedicated, skilled and smart podiatric, orthopedic, hand and plastic surgeons who have a passion and interest in peripheral nerve and how we can make patients better with our understanding of it.

Let’s face it. Podiatrists are master craftsmen when it comes to bone and how to cut it, fixate and manipulate it. When it comes to the peripheral nerve, there is about as much attention paid to it as the small piece of gristle leftover on a 500ºF plate at a Ruth’s Chris Steakhouse until that little discarded gristle suddenly becomes entrapped in the scar, and the patient with a perfectly fixated and very sophisticated podiatric surgery is now in chronic pain.

The AENS is a group of experienced nerve surgeons who share a common desire to figure out nerve pathology, diagnosis and treatment. When you find out about these cherished nuggets, you will wish you had them forever. You will think about all the different patients who presented to you in the past with a perplexing problem and you were not able to help them. Now you can.

The AENS has two upcoming meetings that offer CME opportunities and, more importantly, the opportunity to change your whole practice perspective with the knowledge you will receive.

The Alaskan Fishing Summit will be July 11 to 14. It offers 6 CMEs and features the program “Save the Nerve: The Thinking Man’s Approach to Neuritic Pain” by Peter Bregman, DPM.

The Advanced Peripheral 
Nerve Course will be Nov. 3 to 5 in Fort Worth, Texas. Following that on Nov. 5 to 7 will be the Annual Symposium at the Omni Hotel in Fort Worth. This will feature a comprehensive investigation of the upper and lower extremity nerves.

The peripheral nerve workshop, which is excellent, will be just before the annual meeting so you can attend both and come out of the Lone Star State well prepared to do battle on behalf of the endangered axon. For more info on these meetings, visit

Here is the bottom line: If you want to increase your SCλ and improve your surgical outcomes equation, you have to check this group out.

The photo above was from our last board meeting/cadaver workshop, which shows that even this experienced group cannot get enough cadaveric training and collegiality. (Okay, the picture does not really show that but trust me, these people are insatiable when it comes to the peripheral nerve.)



Terrific Blog Steve! Yes beautifying America from the ground up by fixing bunions has its place but peripheral nerve work is somehow more satisfying. Thank you for plugging the AENS as it is a great group of independent thinkers and the meetings are challenging and diverse. See you in Ft. Worth in November.

Damien Dauphinee, DPM
Immediate Past Present, AENS

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