Teaching speed in the operative theatre: Should case duration benchmark efficiency in general surgical residency programs?

BackgroundTraining surgical residents remains an important mission of academic medical centers. Today, financial pressures guide improved operating room (OR) efficiency and theoretically may affect surgical education. There is no current benchmark with regards to operative time and surgical cases involving General Surgical Residents.Study design971 laparoscopic surgical cases were reviewed for total operative time, closing time, length of stay and 30-day readmission rates. T-test of means and regression analyses were done involving surgical times and point in time during the academic year of the surgical program to gauge whether efficiency improvements exist in the program. Regressions were also done comparing surgical times (total operative and closing time to outcome measures: length of stay, 30-day readmission, and log cost).ResultsResidents had significantly longer procedure times compared to the year prior to commencement of the program where attending surgeons operated without residents by mean t-test (p<0.05). Length of stay increased as total operative time increased in 4 of the 6 category cohort of cases that general surgical residents were involved (p<0.05). There was no improvement in closing time among residents throughout the academic year of their program nor when comparing successive program years.There were strong and statistically significant correlations between total operative time and cost.ConclusionResident participation contributes to increased procedure time and cost for common laparoscopic general surgical procedures. There is also a link between outcomes as measured by length of stay and total operative time. Consequently teaching and/or maintaining efficiency standards may be paramount to maintaining better outcomes. General surgical residency programs may consider benchmarking operative and/or closing times in guiding efficiency in their programs.