The Accuracy of Surgeons' Provided Estimates for the Duration of Hysterectomies: A Pilot Study

Abstract

Study Objective To determine the accuracy of gynecologic surgeons' estimate of operative times for hysterectomies and to compare these with the existing computer-generated estimate at our institution. Design Pilot prospective cohort study (Canadian Task Force classification II-2). Setting Academic tertiary women's hospital in the Northeast United States. Participants Thirty gynecologic surgeons including 23 general gynecologists, 4 gynecologic oncologists, and 3 urogynecologists. Intervention Via a 6-question survey, surgeons were asked to predict the operative time for a hysterectomy they were about to perform. The surgeons' predictions were then compared with the time predicted by the scheduling system at our institution and with the actual operative time, to determine accuracy and differences between actual and predicted times. Patient and surgery data were collected to perform a secondary analysis to determine factors that may have significantly affected the prediction. Measurements and Main Results Of 75 hysterectomies analyzed, 36 were performed abdominally, 18 vaginally, and 21 laparoscopically. Accuracy was established if the actual procedure time was within the 15-minute increment predicted by either the surgeons or the scheduling system. The surgeons accurately predicted the duration of 20 hysterectomies (26.7%), whereas the accuracy of the scheduling system was only 9.3%. The scheduling system accuracy was significantly less precise than the surgeons, primarily due to overestimation (p = .01); operative time was overestimated on average 34 minutes. The scheduling system overestimated the time required to a greater extent than the surgeons for nearly all data examined, including patient body mass index, surgical approach, indication for surgery, surgeon experience, uterine size, and previous abdominal surgery. Conclusion Although surgeons' accuracy in predicting operative time was poor, it was significantly better than that of the computerized scheduling system, which was more likely to overestimate operative time. Journal of Minimally Invasive Gynecology (2015) 22, 57-65 © 2015 AAGL. All rights reserved.

Pelvic examination may be meaningfully taught to novices and be used to predict operating times for laparoscopic excision of endometriosis in one surgical procedure

“…Clinical examination is combined with imaging modalities to improve the accuracy of non‐invasive diagnoses and predict the inclusion of specific skill sets such as colorectal colleagues when rectal disease (for example) is present . In this study, our pragmatic approach was that examination and imaging studies should be used in conjunction to plan procedural time, since this reflects actual clinical practice.…”

“…When a procedure is planned, accurate determination of surgical time optimises scheduling and resource utilisation to the benefit of healthcare stakeholders . Performing a single procedure rather than ‘planning’ laparoscopy improves resource allocation and reduces patient risk, since laparoscopic entry is the component associated with most surgical risk …”

“…Few gynaecological studies have investigated the accuracy of estimating surgical duration and this study aims to assess the accuracy of clinical examination in predicting surgical time. The capacity to teach and learn such skills is imperative, since clinicians with variable skills and exposure levels are required to perform pelvic examinations, and we investigate the capacity to teach medical students clinical skills to determine location of disease and estimation of surgical time.…”

Use of Historical Case Duration Data for Estimating the Duration of Future Cases

“…However, at our institution, the predicted operative time was assigned after looking at the last 10 similar cases performed by the individual surgeon, and after excluding the longest and shortest cases, the time for the remaining 8 cases was averaged [1]. We believe that the discrepancy between the average value and the actual time reported in our study is secondary to the fact we looked at the average variation from the predicted and actual surgical times.…”

Predicting Surgery Duration: Physician Input, Statistical Models, and Combined Models

“…Larsson (2013) reports that while historical averages are more accurate than the surgeon's prediction in general, surgeons are better at identifying long cases. Wright et al (1996) and Roque et al (2015) describe that surgeons are generally more accurate than statistical models.…”