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.
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References
Bartowski R (2009) Problem DRG: bleibt die ärztliche Weiterbildung auf der Strecke? Swiss Knife 3:8–10
Bridges M, Diamond DL (1999) The financial impact of teaching surgical residents in the operating room. Am J Surg 177:28–32
Frank S (2009) Financing graduate medical education. Nat Clin Pract Neurol 5:58–59
Webb TP, Brasel KJ, Redlich PN, Weigelt JA (2010) Putting a price on education: hours and dollars for a general surgery curriculum. Am J Surg 199:126–130
Glauser R (2010) Finanzierung der ärztlichen Weiterbildung. VSAO J 9:8
Babineau TJ, Becker J, Gibbons G, Sentovich S, Hess D, Robertson S et al (2004) The “cost” of operative training for surgical residents. Arch Surg 139:366–369 discussion 369-370
Chung RS (2005) How much time do surgical residents need to learn operative surgery? Am J Surg 190:351–353
Deziel DJ, Millikan KW, Staren ED, Doolas A, Economou SG (1993) The impact of laparoscopic cholecystectomy on the operative experience of surgical residents. Surg Endosc 7:17–21
Haji A, Khan A, Haq A, Ribeiro B (2009) Elective laparoscopic cholecystectomy for surgical trainees: predictive factors of operative time. Surgeon 7:207–210
Hwang CS, Pagano CR, Wichterman KA, Dunnington GL, Alfrey EJ (2008) Resident versus no resident: a single institutional study on operative complications, mortality, and cost. Surgery 144:339–344
Hwang CS, Wichterman KA, Alfrey EJ (2010) The cost of resident education. J Surg Res 163:18–23
Koperna T (2004) How long do we need teaching in the operating room? The true costs of achieving surgical routine. Langenbecks Arch Surg 389:204–208
Hutter MM, Kellogg KC, Ferguson CM, Abbott WM, Warshaw AL (2006) The impact of the 80-hour resident workweek on surgical residents and attending surgeons. Ann Surg 243:864–871 discussion 871-875
Knapp R (2002) Financing graduate medical education and limiting resident work hours: a political assessment. Am J Surg 184:187–195
Telser H, Leukert K (2009) Finanzierung der ärztlichen Weiterbildung aus ökonomischer Sicht. Available at: http://www.polynomics.ch/dokumente/Polynomics_Finanzierung-aerztl-WB_2009.pdf. Accessed 2 May 2011
Steyerberg EW (2009) Dealing with missing values. In: Gail M, Krickeberg K, Samet J, Tsiatis A, Wong W (eds) Clinical prediction models. Springer, New York, pp 113–136
Credit Suisse (2008) Devisendurchschnittskurse 2005–2008. Available at: https://www.credit-suisse.com/ch/unternehmen/kmugrossunternehmen/doc/devisendurchschnittskurse_2008_de.pdf. Accessed 6 Jan 2011
Swiss DRG Casemix Office (2011) webgrouper.swissdrg.org. Available at: https://webgrouper.swissdrg.org. Accessed 23 June 2011
Kauvar DS, Braswell A, Brown BD, Harnisch M (2006) Influence of resident and attending surgeon seniority on operative performance in laparoscopic cholecystectomy. J Surg Res 132:159–163
Z’graggen K, Wehrli H, Metzger A, Buehler M, Frei E, Klaiber C (1998) Complications of laparoscopic cholecystectomy in Switzerland. A prospective 3-year study of 10,174 patients. Swiss Association of Laparoscopic and Thoracoscopic Surgery. Surg Endosc 12:1303–1310
Harrington DT, Roye GD, Ryder BA, Miner TJ, Richardson P, Cioffi WG (2007) A time-cost analysis of teaching a laparoscopic entero-enterostomy. J Surg Educ 64:342–345
Sefr R, Ochmann J (1995) Our experience with early integration of laparoscopic cholecystectomy in surgical residency training. Surg Endosc 9:902–904
Shaikh IA, Sanjay P, Joga K, Yalamarthi S, Daniel T, Amin AI (2009) Are we performing enough emergency laparoscopic cholecystectomies? An experience from a district general hospital. Int J Surg 7:482–484
Wang WN, Melkonian MG, Marshall R, Haluck RS (2001) Postgraduate year does not influence operating time in laparoscopic cholecystectomy. J Surg Res 101:1–3
Businger A, Guller U, Oertli D (2010) Effect of the 50-hour workweek limitation on training of surgical residents in Switzerland. Arch Surg 145:558–563
Allemann P, Schafer M, Demartines N (2010) Critical appraisal of single port access cholecystectomy. Br J Surg 97:1476–1481
O’Shea JS (2010) Individual and social concerns in American surgical education: paying patients, prepaid health insurance, Medicare and Medicaid. Acad Med 85:854–862
Jarman BT, Miller MR, Brown RS, Armen SB, Bozaan AG, Ho GT et al (2004) The 80-hour work week: will we have less-experienced graduating surgeons? Curr Surg 61:612–615
Orlowa P, Siegrista M, Giger M (2007) Die wichtigsten Resultate der Umfrage 2006 bei Assistenzärztinnen und Assistenzärzten. Schweiz Ärzteztg 88:633–642
van der Horst K, Siegrist M, Orlow P, Giger M (2010) Residents’ reasons for specialty choice: influence of gender, time, patient and career. Med Educ 44:595–602
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.
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von Strauss und Torney, M., Dell-Kuster, S., Mechera, R. et al. The cost of surgical training: analysis of operative time for laparoscopic cholecystectomy. Surg Endosc 26, 2579–2586 (2012). https://doi.org/10.1007/s00464-012-2236-1
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DOI: https://doi.org/10.1007/s00464-012-2236-1