Does Surgeon Workload Per Day Affect Outcomes After Pulmonary Lobectomies?

doi:10.1016/j.athoracsur.2012.04.099

The Annals of Thoracic Surgery

Volume 94, Issue 3, September 2012, Pages 966-972

Presented at the Poster Session of the Forty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–Feb 1, 2012.

https://doi.org/10.1016/j.athoracsur.2012.04.099 Get rights and content

Background

Our aim was to evaluate whether the workload of a surgeon, including number of operations, operative time, or number of rooms per day, influenced patient morbidity or mortality after pulmonary lobectomy.

Methods

The records of all patients who underwent pulmonary lobectomy at our institution during 2 years (2007–2009) by 6 surgeons were retrospectively reviewed. Surgeon workload per day and individual patient variables were evaluated. Both univariate and multivariate analyses were performed to identify risk factors for patient morbidity and mortality.

Results

We analyzed 481 patients (269 men, 112 women) whose median age was 68 years (range, 20 to 94 years). Operative mortality occurred in 6 patients (1.25%), and morbidity occurred in 198 patients (41%). On univariate analysis, the total number of hours a surgeon operated per day was a significant predictor of complications (odds ratio, 1.032; p = 0. 048) and length of stay (average increase of 0.17 days for each additional hour; p = 0.004). There were multiple patient variables that were significant predictors of outcome. On multivariate analysis, which adjusted for patient variables, the total number of hours a surgeon operated per day remained a significant predictor of complications (odds ratio, 1.036; p = 0.03) and increased length of stay (average increase of 0.16 days for each additional hour; p = 0.006). On multivariate analysis, patient variables of age, forced expiratory volume In 1 second, and renal failure were significant predictors of outcome.

Conclusions

The total number of hours a surgeon operates per day is independently associated with an increased risk of complications when performing pulmonary lobectomies. This could be related to surgeon fatigue associated with longer operative days. However, other patient variables are also associated with outcome. The relationship among these factors needs to be better understood with larger-scale models on a multiinstitutional level.

Section snippets

Material and Methods

We identified 497 patients who underwent pulmonary lobectomies for benign or malignant disease from January 1, 2008, to December 31, 2009, at the Mayo Clinic, Minnesota. Authorization for this study was obtained from the Mayo Clinic Institutional Review Board, which waived informed consent as the study was considered to be low risk. The following exclusions were made: 10 patients who had refused research authorization, 3 emergency lobectomies, and 2 pediatric patients (younger than 16 years of

Complications

One hundred ninety-eight patients (41%) experienced either a major or minor postoperative complication as listed in Table 3. Postoperative mortality was 1.25% (n = 6) and occurred any time from postoperative days 0 to 69. There were no intraoperative deaths, and all 6 deaths occurred during the same hospital admission for surgery. The causes of death were as follows: complications from intraoperative pulmonary artery injuries and massive hemorrhage (2); sudden hemoptysis on postoperative day 10

Comment

Health care quality and delivery have acquired a place among the hotly contested topics during the past two decades. Changes in government policies and economic reasons have fueled the debate about the best way to evaluate quality in health care. Patient morbidity and mortality are among the most commonly used variables that currently exist for the evaluation of quality of health delivery systems. Increasing calls for transparency and the easy availability of information through the Internet

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Original articleGeneral thoracicDoes Surgeon Workload Per Day Affect Outcomes After Pulmonary Lobectomies?

Background

Methods

Results

Conclusions

Section snippets

Material and Methods

Complications

Comment

J Am Coll Surg

Surgery

Adv Surg

Ann Thorac Surg

Ann Thorac Surg

J Plast Reconstr Aesthet Surg

J Am Coll Surg

J Thorac Cardiovasc Surg

Original article
General thoracic
Does Surgeon Workload Per Day Affect Outcomes After Pulmonary Lobectomies?