Elsevier

Surgery for Obesity and Related Diseases

Volume 11, Issue 1, January–February 2015, Pages 207-213
Surgery for Obesity and Related Diseases

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

https://doi.org/10.1016/j.soard.2014.03.018Get rights and content

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.

Section snippets

Data sources and study population

The MBSC is a payor-funded consortium of hospitals and surgeons who perform bariatric surgery in Michigan. The collaborative collects data on nearly all patients undergoing bariatric surgery in the state each year, and utilizes center-specific outcomes feedback and quarterly collaborative meetings to promote quality improvement and best practices among participating surgeons and hospitals. The specifics of data collection and patient follow-up have been detailed elsewhere [12], [13], [14].

In

Results

A total of 16,344 patients underwent primary laparoscopic Roux-en-Y gastric bypass by 34 surgeons during the study period. Table 1 details the baseline characteristics of surgeons included in the study cohort, according to tercile of median surgeon operative time. Compared to surgeons in the fastest tercile, surgeons in the slowest tercile required 53 additional minutes to complete a gastric bypass procedure [median (interquartile range) 139 (133–150) versus 86 (69–91), P<.001]. A much higher

Discussion

This is the first population-based study to investigate the influence of surgeon median operative time on outcomes after complex laparoscopic surgery. In this analysis, we found that patients undergoing laparoscopic Roux-en-Y gastric bypass by slower surgeons have greater odds of any complication, prolonged length of stay and VTE, even after accounting for patient and surgeon characteristics, and the complex interactions between median surgeon operative time, gastrojejunostomy technique and

Disclosures

Dr. John Birkmeyer is chief scientific officer and has an equity interest in ArborMetrix Inc, which provides software and analytics for measuring hospital quality and efficiency. The company had no role in this study. All remaining authors have no conflicts of interest.

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