Determinants of operative time in thyroid surgery: A prospective multicenter study of 3454 thyroidectomies

Abstract

ObjectiveTo identify the determinants of operative time for thyroidectomy and quantify the relative influence of preoperative and intra-operative factors.BackgroundAnticipation of operative time is key to avoid both waste of hospital resources and dissatisfaction of the surgical staff. Having an accurate and anticipated planning would allow a rationalized operating room use and may improve patient flow and staffing level.MethodsWe conducted a prospective, cross-sectional study between April 2008 and December 2009. The operative time of 3454 patients who underwent thyroidectomy performed by 28 surgeons in five academic hospitals was monitored. We used multilevel linear regression to model determinants of operative time while accounting for the interplay of characteristics specific to surgeons, patients, and surgical procedures. The relative impact of each variable on operative time was estimated.ResultsOverall, 86% (99% CI 83 to 89) of operative time variation was related to preoperative variables. Surgeon characteristics accounted for 32% (99% CI 29 to 35) of variation, center location for 29% (99% CI 25 to 33), and surgical procedure or patient variables for 24% (99% CI 20 to 27). Operative time was significantly lower among experienced surgeons having practiced from 5–19 years (-21.8 min, P<0.05), performing at least 300 thyroidectomies per year (-28.8 min, P<0.05), and with increasing number of thyroidectomies performed the same day (-11.7min, P<0.001). Conversely, operative time increased in cases of procedure supervision by a more experienced surgeon (+20.0 min, P<0.001). The remaining 13.0% of variability was attributable to unanticipated technical difficulties at the time of surgery.ConclusionsVariation in thyroidectomy duration is largely explained by preoperative factors, suggesting that it can be accurately anticipated. Prediction tools allowing better regulation of patient flow in operating rooms appears feasible for both working conditions and cost management.

Monobloc Total Thyroidectomy Using Sealing Devices: Preliminary Results and Comparative Analysis

“…Operative time is greatly influenced by the surgeon's experience, as shown by Patoir et al (11). The mean operating time in this study was not statistically significantly different between groups, or from the average time of 86 minutes reported in the literature.…”

Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure‐targeted analysis

“…The association between prolonged operative time and anasotmotic leak following esophagectomy, while also a novel finding, is more straightforward . Intuitively, longer operative times may frequently represent more technically challenging cases, which could inherently be expected to have an increased risk of anastomotic complications.…”

“…Similarly, others have also reported that anatomic factors significantly influence operative time and reflect operative complexity for rectal and hepatic resections. However, Patoir et al found that surgeon characteristics and center location accounted for 32% and 29%, respectively, of operative time variation during thyroid surgery, suggesting that factors other than operative complexity may also contribute to operative time. In consideration of the above, the etiology of prolonged operative time is likely multifactorial and varies across surgical settings.…”

Predictive model of operative time in transoral endoscopic thyroidectomy vestibular approach

“…Although Consorti OT. [40][41][42] On univariate analysis, we found preoperative history of Graves' to be significantly associated with increased OT; however, this relationship was not significant on multivariate analysis. Preoperative thyroiditis was not significant on either univariate or multivariate analysis.…”