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Surgical Endoscopy

, Volume 26, Issue 9, pp 2579–2586 | Cite as

The cost of surgical training: analysis of operative time for laparoscopic cholecystectomy

  • M. von Strauss und Torney
  • S. Dell-Kuster
  • R. Mechera
  • R. Rosenthal
  • I. Langer
Article

Abstract

Background

Duration of surgery is a main cost factor of surgical training. The purpose of this analysis of operative times for laparoscopic cholecystectomies (LC) was to quantify the extra time and related costs in regards to the surgeons’ experience in the operating room (OR).

Methods

All LC performed between January 01, 2005 and December 31, 2008 in 46 hospitals reporting to the database of the Swiss Association for Quality Management in Surgery (AQC) were analyzed (n = 10,010). Four levels of seniority were specified: resident (R), junior consultant (JC), senior consultant (SC), and attending surgeon (AS). The differences in operative time according to seniority were investigated in a multivariable log-linear and median regression analysis controlling for possible confounders. The OR costs were calculated by using a full cost rate in a teaching hospital.

Results

A total of 9,208 LC were available for analysis; 802 had to be excluded due to missing data (n = 212) or secondary major operations (n = 590). Twenty-eight percent of the LC were performed by R as teaching operations (n = 2,591). Compared with R, the multivariable analysis of operative time showed a median difference of −2.5 min (−9.0; 4.8) for JC and −18 min (−25; −11) for SC and −28 min (−35; −10) for AS, respectively. The OR minute costs were €17.57, resulting in incremental costs of €492 (159; 615) per operation in case of tutorial assistance.

Conclusions

The proportion of LC performed as tutorial assistance for R remains low. Surgical training in the OR causes relevant case-related extra time and therefore costs.

Keywords

Cholecystectomy Education Costs < Technical Training < Endoscopy 

Notes

Acknowledgments

The authors thank Luzi Rageth and the Swiss Association for Quality Management in Surgery (AQC) for their support in this investigation.

Disclosures

Drs. von Strauss, Dell-Kuster, Mechera, and Langer, and Prof. Rosenthal have no conflicts of interest or financial ties to disclose.

Supplementary material

464_2012_2236_MOESM1_ESM.doc (376 kb)
Patients’ characteristics according to the experience level of the surgeon (DOC 376 kb)

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • M. von Strauss und Torney
    • 1
    • 2
  • S. Dell-Kuster
    • 1
    • 3
  • R. Mechera
    • 1
    • 2
  • R. Rosenthal
    • 1
  • I. Langer
    • 4
  1. 1.Department of SurgeryBasel University HospitalBaselSwitzerland
  2. 2.Department of SurgeryCantonal Hospital BruderholzBruderholzSwitzerland
  3. 3.Institute for Clinical Epidemiology and Biostatistics, Basel University HospitalBaselSwitzerland
  4. 4.Department of SurgeryLindenhof Hospital BernBernSwitzerland

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