Influence of median surgeon operative duration on adverse outcomes in bariatric surgery

Bradley N. Reames, Daniel Bacal, Robert W. Krell, John D. Birkmeyer, Nancy J.O. Birkmeyer, Jonathan F. Finks

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background Evidence suggests that prolonged operative time adversely affects surgical outcomes. However, whether faster surgeons have better outcomes is unclear, as a surgeon's speed could reflect skill and efficiency, but may alternatively reflect haste. This study evaluates whether median surgeon operative time is associated with adverse surgical outcomes after laparoscopic Roux-en-Y gastric bypass. Methods We performed a retrospective cohort study using statewide clinical registry data from the years 2006 to 2012. Surgeons were ranked by their median operative time and grouped into terciles. Multivariable logistic regression with robust standard errors was used to evaluate the influence of median surgeon operative time on 30-day surgical outcomes, adjusting for patient and surgeon characteristics, trainee involvement, concurrent procedures, and the complex interaction between these variables. Results A total of 16,344 patients underwent surgery during the study period. Compared to surgeons in the fastest tercile, slow surgeons required 53 additional minutes to complete a gastric bypass procedure (median [interquartile range] 139 [133-150] versus 86 [69-91], P<.001). After adjustment for patient characteristic only, slow surgeons had significantly higher adjusted rates of any complication, prolonged length of stay, emergency department visits or readmissions, and venous thromboembolism (VTE). After further adjustment for surgeon characteristics, resident involvement, and the interaction between these variables, slow surgeons had higher rates of any complication (10.5% versus 7.1%, P =.039), prolonged length of stay (14.0% versus 4.4%, P =.002), and VTE (0.39% versus.22%, P<.001). Conclusion Median surgeon operative duration is independently associated with adjusted rates of certain adverse outcomes after laparoscopic Roux-en-Y gastric bypass. Improving surgeon efficiency while operating may reduce operative time and improve the safety of bariatric surgery.

Original languageEnglish (US)
Pages (from-to)207-213
Number of pages7
JournalSurgery for Obesity and Related Diseases
Volume11
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

Bariatric Surgery
Operative Time
Gastric Bypass
Venous Thromboembolism
Surgeons
Length of Stay
Registries
Hospital Emergency Service
Cohort Studies
Retrospective Studies

Keywords

  • Bariatric surgery
  • Laparoscopic Roux-en-Y gastric bypass
  • Outcomes research
  • Postoperative complications
  • Quality of care

ASJC Scopus subject areas

  • Surgery

Cite this

Influence of median surgeon operative duration on adverse outcomes in bariatric surgery. / Reames, Bradley N.; Bacal, Daniel; Krell, Robert W.; Birkmeyer, John D.; Birkmeyer, Nancy J.O.; Finks, Jonathan F.

In: Surgery for Obesity and Related Diseases, Vol. 11, No. 1, 01.01.2015, p. 207-213.

Research output: Contribution to journalArticle

Reames, Bradley N. ; Bacal, Daniel ; Krell, Robert W. ; Birkmeyer, John D. ; Birkmeyer, Nancy J.O. ; Finks, Jonathan F. / Influence of median surgeon operative duration on adverse outcomes in bariatric surgery. In: Surgery for Obesity and Related Diseases. 2015 ; Vol. 11, No. 1. pp. 207-213.
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abstract = "Background Evidence suggests that prolonged operative time adversely affects surgical outcomes. However, whether faster surgeons have better outcomes is unclear, as a surgeon's speed could reflect skill and efficiency, but may alternatively reflect haste. This study evaluates whether median surgeon operative time is associated with adverse surgical outcomes after laparoscopic Roux-en-Y gastric bypass. Methods We performed a retrospective cohort study using statewide clinical registry data from the years 2006 to 2012. Surgeons were ranked by their median operative time and grouped into terciles. Multivariable logistic regression with robust standard errors was used to evaluate the influence of median surgeon operative time on 30-day surgical outcomes, adjusting for patient and surgeon characteristics, trainee involvement, concurrent procedures, and the complex interaction between these variables. Results A total of 16,344 patients underwent surgery during the study period. Compared to surgeons in the fastest tercile, slow surgeons required 53 additional minutes to complete a gastric bypass procedure (median [interquartile range] 139 [133-150] versus 86 [69-91], P<.001). After adjustment for patient characteristic only, slow surgeons had significantly higher adjusted rates of any complication, prolonged length of stay, emergency department visits or readmissions, and venous thromboembolism (VTE). After further adjustment for surgeon characteristics, resident involvement, and the interaction between these variables, slow surgeons had higher rates of any complication (10.5{\%} versus 7.1{\%}, P =.039), prolonged length of stay (14.0{\%} versus 4.4{\%}, P =.002), and VTE (0.39{\%} versus.22{\%}, P<.001). Conclusion Median surgeon operative duration is independently associated with adjusted rates of certain adverse outcomes after laparoscopic Roux-en-Y gastric bypass. Improving surgeon efficiency while operating may reduce operative time and improve the safety of bariatric surgery.",
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AB - Background Evidence suggests that prolonged operative time adversely affects surgical outcomes. However, whether faster surgeons have better outcomes is unclear, as a surgeon's speed could reflect skill and efficiency, but may alternatively reflect haste. This study evaluates whether median surgeon operative time is associated with adverse surgical outcomes after laparoscopic Roux-en-Y gastric bypass. Methods We performed a retrospective cohort study using statewide clinical registry data from the years 2006 to 2012. Surgeons were ranked by their median operative time and grouped into terciles. Multivariable logistic regression with robust standard errors was used to evaluate the influence of median surgeon operative time on 30-day surgical outcomes, adjusting for patient and surgeon characteristics, trainee involvement, concurrent procedures, and the complex interaction between these variables. Results A total of 16,344 patients underwent surgery during the study period. Compared to surgeons in the fastest tercile, slow surgeons required 53 additional minutes to complete a gastric bypass procedure (median [interquartile range] 139 [133-150] versus 86 [69-91], P<.001). After adjustment for patient characteristic only, slow surgeons had significantly higher adjusted rates of any complication, prolonged length of stay, emergency department visits or readmissions, and venous thromboembolism (VTE). After further adjustment for surgeon characteristics, resident involvement, and the interaction between these variables, slow surgeons had higher rates of any complication (10.5% versus 7.1%, P =.039), prolonged length of stay (14.0% versus 4.4%, P =.002), and VTE (0.39% versus.22%, P<.001). Conclusion Median surgeon operative duration is independently associated with adjusted rates of certain adverse outcomes after laparoscopic Roux-en-Y gastric bypass. Improving surgeon efficiency while operating may reduce operative time and improve the safety of bariatric surgery.

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