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Biostatistics grad among co-founders of digital platform to improve surgical skills

Bryan Comstock
Bryan Comstock

Johnson & Johnson recently announced acquisition of C-SATS, a University of Washington startup that developed a revolutionary and cost-effective platform for evaluating surgical skills.

Bryan Comstock, one of the co-founders who developed C-SATS, is a graduate from the UW Department of Biostatistics (MS program, 2004) and now works as a senior biostatistician and operations director for the Center for Biomedical Statistics (CBS) housed within the Department of Biostatistics.

Comstock explains why the C-SATS is such a game-changer, “To become a surgeon requires an extensive amount of training followed by ongoing review of selected cases. The standard for review is for another surgeon or proctor to either review the surgeon’s performance during live surgery or review the performance by videotape at a later point in time.”

But fundamental problems exist with this system including the high cost of paying for a peer review, the time it takes to conduct the review as well as case selection and review selection bias. C-SATS eliminates these issues by having a large pool of surgeons and trained reviewers conduct anonymous assessments of surgical videos.

The idea for C-SATS began with a request submitted to CBS to design a study to assess how regular people (the crowd) who watched a video of a surgery would rate a surgeon’s technical performance compared to ratings by expert surgical reviewers.

Initial findings showed that the average score calculated from 500 random crowd workers was within a tenth of a point of the average score measured from 10 peer surgeons and that the confidence interval around the average crowd worker score was narrow.

“The ability to capture surgical performance rating data rapidly, objectively, and accurately fueled the idea of commercializing this as a bargain replacement for the current process,” said Comstock.

C-SATS was formally formed in 2014 with the goal of benefiting patients and healthcare overall by improving outcomes and reducing costs. Comstock was one of five original co-founding members, along with two UW engineers, a pediatric surgeon at UW and Seattle Children’s Hospital, and a business partner, who came onboard after hearing C-SATS presentation at UW’s CoMotion lab.

Comstock’s role with C-SATS was to guide the start-up with development and analysis of the scoring process, and to help design research studies to evaluate those scores against other external data such as peer-based scores, excess blood loss, operating room time, hospital length of stay, hospital readmission, etc.

His greatest challenge along the way? “Pie charts,” said Comstock.  “As a former student of the Department of Biostatistics, I was trained never to make pie charts so I stink at making pie charts. However, for some audiences, pie charts are widely used and understood. “

Could C-SATS have been successful without a biostatistician? “Perhaps, but not with the same level of depth and rigor,” said Comstock.  “I have learned through this process that people with a variety of backgrounds (business, computer science, engineering, and medicine) can be very adept with analyzing and interpreting data, but the field of biostatistics offers an extra layer of credibility that plays an integral role within the C-SATS business. As a biostatistician, I offered a different perspective and approach towards dealing with hierarchical and longitudinal data, multivariable adjustment of scores and regression modeling, bias and confounding, and rigorous study design.

“My takeaway impression from this exercise is that time, creativity, and building a diverse team from a variety of backgrounds helped this start-up become successful,” concludes Comstock.

C-SATS will be integrated into the Johnson & Johnson Institute’s extensive on-site and online digital learning and education offerings later in the year.