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The use of patient factors to improve the prediction of operative duration using laparoscopic cholecystectomy

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Abstract

Background

Reliable prediction of operative duration is essential for improving patient and care team satisfaction, optimizing resource utilization and reducing cost. Current operative scheduling systems are unreliable and contribute to costly over- and underestimation of operative time. We hypothesized that the inclusion of patient-specific factors would improve the accuracy in predicting operative duration.

Methods

We reviewed all elective laparoscopic cholecystectomies performed at a single institution between 01/2007 and 06/2013. Concurrent procedures were excluded. Univariate analysis evaluated the effect of age, gender, BMI, ASA, laboratory values, smoking, and comorbidities on operative duration. Multivariable linear regression models were constructed using the significant factors (p < 0.05). The patient factors model was compared to the traditional surgical scheduling system estimates, which uses historical surgeon-specific and procedure-specific operative duration. External validation was done using the ACS-NSQIP database (n = 11,842).

Results

A total of 1801 laparoscopic cholecystectomy patients met inclusion criteria. Female sex was associated with reduced operative duration (−7.5 min, p < 0.001 vs. male sex) while increasing BMI (+5.1 min BMI 25–29.9, +6.9 min BMI 30–34.9, +10.4 min BMI 35–39.9, +17.0 min BMI 40 + , all p < 0.05 vs. normal BMI), increasing ASA (+7.4 min ASA III, +38.3 min ASA IV, all p < 0.01 vs. ASA I), and elevated liver function tests (+7.9 min, p < 0.01 vs. normal) were predictive of increased operative duration on univariate analysis. A model was then constructed using these predictive factors. The traditional surgical scheduling system was poorly predictive of actual operative duration (R 2 = 0.001) compared to the patient factors model (R 2 = 0.08). The model remained predictive on external validation (R 2 = 0.14).The addition of surgeon as a variable in the institutional model further improved predictive ability of the model (R 2 = 0.18).

Conclusion

The use of routinely available pre-operative patient factors improves the prediction of operative duration during cholecystectomy.

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Abbreviations

ACS-NSQIP:

American College of Surgery National Surgical Quality Improvement Program

ASA:

American Society of Anesthesiologists

BMI:

Body Mass Index

CHAID:

Chi-squared Automatic Interaction Detection

CPT:

Current Procedural Terminology

LFT:

Liver Function Test

WBC:

White Blood Cell count

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Acknowledgments

This publication was made possible by funding from the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. The authors would also like to acknowledge Mayo Clinic Anesthesia Clinical Research Unit for their support and help with data extraction.

Author contributions

Thiels, Yu, Habermann, and Bingener contributed to the study design. Thiels, Yu, Abdelrahman, Habermann, Hallbeck, Pasupathy, and Bingener contributed to the analysis and interpretation. All authors contributed to the drafting and critical revisions of the manuscript and gave final approval prior to publication.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Cornelius A. Thiels, Susan Hallbeck & Juliane Bingener

  2. Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA

    Cornelius A. Thiels, Denny Yu, Amro M. Abdelrahman, Elizabeth B. Habermann, Susan Hallbeck & Kalyan S. Pasupathy

  3. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Denny Yu, Amro M. Abdelrahman, Elizabeth B. Habermann, Susan Hallbeck & Kalyan S. Pasupathy

  4. School of Industrial Engineering, Purdue University, West Lafayette, IN, USA

    Denny Yu

Authors
  1. Cornelius A. Thiels
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  2. Denny Yu
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  3. Amro M. Abdelrahman
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  4. Elizabeth B. Habermann
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  5. Susan Hallbeck
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  6. Kalyan S. Pasupathy
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  7. Juliane Bingener
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Corresponding author

Correspondence to Juliane Bingener.

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Disclosures

Drs. Thiels, Yu, Abdelrahman, Habermann, Hallbeck, and Pasupathy have no conflicts of interest or financial ties to disclose. Dr. Bingener is on the Surgeon Advisory Board of Titan Medical Inc. Support provided by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (Thiels, Yu, Abdelrahman, Habermann, Hallbeck, Pasupathy).

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Thiels, C.A., Yu, D., Abdelrahman, A.M. et al. The use of patient factors to improve the prediction of operative duration using laparoscopic cholecystectomy. Surg Endosc 31, 333–340 (2017). https://doi.org/10.1007/s00464-016-4976-9

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  • DOI: https://doi.org/10.1007/s00464-016-4976-9

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