Resident impact on operative duration for elective general surgical procedures

Dull, Matthew; Gier, Chad; Carroll, Joseph T.; Hutchison, Dylan; Gawel, Jeffrey C.

doi:10.1016/j.amjsurg.2016.10.031

Cited by 21 publications

(13 citation statements)

References 9 publications

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“…As for associated diseases, we opted for the use of SOI in the stratification of cases, since this score is what is usually reported in the literature [18][19][20] . The mean duration of our procedures was about 52 minutes, other works reporting values between 37 and 93 minutes in university hospitals [21][22][23][24][25][26][27][28] .…”

Section: Discussionmentioning

confidence: 60%

Laparoscopic cholecystectomy performed by general surgery residents. Is it safe? How much does it cost?

Sousa

Tustumi

Steinman

et al. 2021

Rev. Col. Bras. Cir.

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Objective: to evaluate the effectiveness and safety of laparoscopic cholecystectomies performed by residents of the first and second-year of a general surgery residency program. We studied the primary total cost of treatment and complication rates as primary outcomes, comparing the groups operated by senior and resident surgeons. Methods: this was a retrospective cohort study of patients who underwent laparoscopic cholecystectomy performed in a training hospital of large surgical volume in Brazil, in the period between June 1, 2018 and May 31, 2019. The study population comprised patients who underwent elective cholecystectomy due to uncomplicated chronic calculous cholecystitis or to the presence of gallbladder polyps with surgical indication. We divided the cases into three groups, based on the graduation of the main surgeon at the time of the procedure: first-year residents (R1), second-year residents (R2), and trained general surgeons (GS). Results: during the study period, 1,052 laparoscopic cholecystectomies were performed, of which 1,035 procedures met the inclusion criteria, with 78 (7.5%) patients operated on with the participation of first-year residents (R1), 500 (48.3%) patients with the participation of second-year residents (R2), and 457 (44.2%) with the participation of senior surgeons only. There was no difference in conversion rates, complications, and reporting of adverse events between groups. We observed a significant difference regarding hospitalization costs (p = 0.003), with a higher mean for the patients operated with the participation of R1, of US$ 2,671.13, versus US$ 2,414.60 and US$ 2,396.24 for the procedures performed by senior surgeons and R2, respectively. Conclusions: laparoscopic cholecystectomy with the participation of residents is safe, even in their first years of training. There is an additional cost of about 10% in the treatment of patient operated with the participation of first-year residents. There was no significant difference in the cost of the group operated by second-year residents.

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Section: Discussionmentioning

confidence: 60%

Laparoscopic cholecystectomy performed by general surgery residents. Is it safe? How much does it cost?

Sousa

Tustumi

Steinman

et al. 2021

Rev. Col. Bras. Cir.

View full text Add to dashboard Cite

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“…One reason for this may be the nature of our hospital as a tertiary training institution, with junior or senior resident involvement in the vast majority of our cases. The involvement of resident trainees has been shown to be associated with increased operative times for several surgeries, including total thyroidectomy and lobectomy 21‐27 . This discrepancy may also suggest further progression is possible beyond the initial point of proficiency and plateau, although further investigation is needed as multiple factors may be involved.…”

Section: Discussionmentioning

confidence: 99%

Predictive model of operative time in transoral endoscopic thyroidectomy vestibular approach

et al. 2020

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Background: Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) has demonstrated excellent safety and is receiving wider use in North America. Understanding which factors lead to operative difficulty, as evaluated by operative time (OT), may help to improve safety and refine indications for this procedure. Methods: Cases of TOETVA performed at our institution were reviewed. Multivariate linear regression was performed using patient demographics, thyroid characteristics, and operative variables to predict OT. Results: A total of 207 cases were included for analysis. A multivariate linear regression model, controlling for age, sex, and BMI, was developed from 104 cases with an R 2 of 0.47 (p < 0.001). Cross-validation on 103 remaining cases showed root-mean-square error of 46.37. Total thyroidectomy and lobe size were the only significant predictors (p < 0.001). Conclusions: We successfully developed a model to predict OT for TOETVA based on preoperative and operative variables. Lobe size, but not BMI, is a significant predictor of OT.

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“…Specific surgical properties, including operative time, have been well documented in the literature and have been used to determine operative learning curves (5,6). On the other hand, operations performed in a rush might be associated with increased occurrence of errors during surgery (7,8).…”

Section: Introductionmentioning

confidence: 99%

Risk Factors Related to Operative Duration and Their Relationship With Clinical Outcomes in Pediatric Patients Undergoing Roux-en-Y Hepaticojejunostomy

et al. 2020

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Background: Operative duration might be important for perioperative morbidity, and its involvement has not been fully characterized in pediatric patients. We identified perioperative variables associated with operative duration and determined their influence on clinical outcomes in pediatric patients.Methods: We retrospectively reviewed 701 patients who underwent elective removal of choledochal cysts followed by Roux-en-Y hepaticojejunostomy. The patients were separated into the long operative time group (>165 min) and short operative time group (<165 min) based on the median operative time (165 min). Propensity score matching was performed to adjust for any potential selection bias. The independent risk factors for operative time were determined using multivariable logistic regression analyses.Results: The operative time was often increased by excision difficulty caused by a larger choledochal cyst size (OR = 1.56; 95% CI, 1.09–2.23; p < 0.001), a greater BMI (OR = 1.02; 95% CI, 1.00–1.15; p = 0.018), and older age (OR = 1.17; 95% CI, 1.02–1.39; p = 0.012) in the multivariate analysis. A long surgical duration was associated with delayed gastrointestinal functional recovery, as measured using the time to first defecation (p = 0.027) and first bowel movement (p = 0.019). Significantly lower levels of serum albumin were found in the long operative time group than in the short operative time group (p = 0.0035). The total length of postoperative hospital stay was longer in patients in the long operative time group (7.51 ± 2.03 days) than in those in the short operative time group (6.72 ± 1.54 days, p = 0.006).Conclusions: Our data demonstrated that a short operative time was associated with favorable postoperative results. The influencing factors of operative time should be ameliorated to achieve better outcomes.

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Resident impact on operative duration for elective general surgical procedures

Cited by 21 publications

References 9 publications

Laparoscopic cholecystectomy performed by general surgery residents. Is it safe? How much does it cost?

Laparoscopic cholecystectomy performed by general surgery residents. Is it safe? How much does it cost?

Predictive model of operative time in transoral endoscopic thyroidectomy vestibular approach

Risk Factors Related to Operative Duration and Their Relationship With Clinical Outcomes in Pediatric Patients Undergoing Roux-en-Y Hepaticojejunostomy

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