Teaching surgery takes time: the impact of surgical education on time in the operating room

Abstract

Background: It is generally accepted that surgical training is associated with increased surgical duration. The purpose of this study was to determine the magnitude of this increase for common surgical procedures by comparing surgery duration in teaching and nonteaching hospitals.Methods: This retrospective population-based cohort study included all adult residents of Ontario, Canada, who underwent 1 of 14 surgical procedures between 2002 and 2012. We used several linked administrative databases to identify the study cohort in addition to patient-, surgeon-and procedure-related variables. We determined surgery duration using anesthesiology billing records. Negative binomial regression was used to model the association between teaching versus nonteaching hospital status and surgery duration. Results:Of the 713 573 surgical cases included in this study, 20.8% were performed in a teaching hospital. For each procedure, the mean surgery duration was significantly longer for teaching hospitals, with differences ranging from 5 to 62 minutes across individual procedures in unadjusted analyses (all p < 0.001). In regression an alysis, procedures performed in teaching hospitals were associated with an overall 22% (95% confidence interval 20%-24%) increase in surgery duration, adjusting for patient-, surgeon-and procedure-related variables as well as the clustering of patients within surgeons and hospitals. Conclusion:Our results show that a wide range of surgical procedures require significantly more time to perform in teaching than nonteaching hospitals. Given the magnitude of this difference, the impact of surgical training on health care costs and clinical outcomes should be a priority for future studies.Contexte : Il est généralement admis que la formation chirurgicale est associée à des interventions plus longues. L'objectif de la présente étude était de déterminer l'ampleur de cette augmentation pour les chirurgies courantes en comparant la durée des interventions dans les hôpitaux universitaires et les autres hôpitaux. Méthodes :Dans le cadre d'une étude de cohorte rétrospective basée sur la population, nous avons recensé tous les résidents adultes de l'Ontario (Canada) qui ont subi une intervention chirurgicale parmi une liste de 14 entre 2002 et 2012. À l'aide de plusieurs bases de données administratives reliées, nous avons constitué la cohorte de l'étude et recueilli des variables associées aux patients, aux chirurgiens et aux interventions. Nous avons déterminé la durée des opérations à partir des dossiers de facturation d'anesthésiologie. Une régression binomiale négative a été utilisée pour modéliser le lien entre le statut des hôpitaux -universitaires ou non -et la durée.Résultats : Des 713 573 chirurgies à l'étude, 20,8 % ont eu lieu dans un hôpital universitaire. Dans tous les cas, la durée moyenne était significativement plus longue dans les hôpitaux universitaires, les écarts variant de 5 à 62 minutes pour chaque intervention dans les analyses non corrigées (p < 0,001 dans tous les cas). Selon l'analyse...

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