Variations in procedure time based on surgery resident postgraduate year level

• Published in: The Journal of surgical research 2013-12, Vol.185 (2), p.570-574
• Main Authors: Johnson, Jeremy J., MD, Thurman, Joseph B., BS, Garwe, Tabitha, PhD, Wallace, Kris, MBA, RN, Anastakis, Dimitri J., MD, FACS, Lees, Jason S., MD, FACS
• Format: Article
• Language: English
• Subjects: Adult; Cholecystectomy, Laparoscopic - economics; Cholecystectomy, Laparoscopic - education; Cholecystectomy, Laparoscopic - standards; Clinical Competence; Education, Medical, Graduate - economics; Education, Medical, Graduate - standards; Female; General Surgery - education; Hospital Costs; Humans; Internship and Residency - economics; Internship and Residency - standards; Male; Middle Aged; Operating room costs; Operating Rooms - economics; Operative procedure time; Operative Time; Pancreaticoduodenectomy - economics; Pancreaticoduodenectomy - education; Pancreaticoduodenectomy - standards; Retrospective Studies; Surgery; Surgical resident education
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2013.06.056

Abstract Background With increasing scrutiny being placed on the allocation of health care dollars, data supporting the increased resources used to teach residents in the operating room (OR) are lacking. Methods All cases of patients undergoing laparoscopic cholecystectomies (LCs) and pancreaticoduodenectomies (PDs) from July 1, 2006 to July 1, 2011 were analyzed. Procedures were excluded based on the following: more than one resident listed in the operative report, with the exception of interns; LC requiring cholangiogram or conversion to an open procedure; or if a PD required additional procedures. Multiple linear regression was used to evaluate the association between procedure time and postgraduate year (PGY), adjusting for patient age and estimated blood loss. Results A total of 236 PDs and 357 LCs were included in the study. For LCs, after multiple linear regression, the association between procedure time and resident PGY was marginally significant ( P  = 0.0519) and suggested an inverse relationship; for every increase in resident PGY, there was a 2.66-min decrease in OR time. Based on our institution's figure of $18.13/min of OR time, the cost difference between PGYs 1 and 5 performing a LC would be $192.90 per case. For PDs, however, the association between procedure time and resident PGY was not significant. Conclusions Junior residents likely prolong procedure times for more basic procedures such as LC but not for more complex procedures such as PD.