Matthew B Dull, MD1, David J Hobbs, MD1, Joseph T Carroll, MD1, Chad P Gier2, Dylan D Hutchison2, Jeffrey C Gawel, MD3. 1Grand Rapids Medical Education Partners, 2Michigan State University College of Human Medicine, 3Spectrum Health Medical Group
INTRODUCTION: In an effort to reduce costs and increase efficiency, general surgeons are increasingly performing operations at outpatient surgical centers (OSC). There is mounting pressure to complete cases in an expeditious manner, but little is known regarding potential obstacles to efficiency in the OSC. The purpose of this study was to identify other factors that increase operative duration in the outpatient surgical center setting for elective laparoscopic cholecystectomies.
METHODS AND PROCEDURES: A single-center retrospective review was performed over a three year period (2012-2015). Demographic, clinical and outcome data was obtained on laparoscopic cholecystectomy performed by a high-volume single general surgery at an OSC. Multivariate regression analysis was performed to identify factors associated with increased operative duration.
RESULTS:
The study population consisted of 279 patients who underwent laparoscopic cholecystectomy at the OSC. The mean operative duration for laparoscopic cholecystectomy was 27.7 minutes.
Multivariate regression analysis did not associate increased age or male gender with increased operative duration. Increased BMI was found to be associated with longer operative duration—a 10 unit increase in BMI was associated with a 1.9 minute increase in operative duration (p < 0.01). Resident acting as surgeon junior added 3.6 minutes to the case (p < 0.01). Smoking increased operative time 3.6 minutes (p < 0.05). Iatrogenic perforation of the gallbladder was the strongest predictor of a longer operation, slowing the operation by 6.6 minutes (p < 0.001).
CONCLUSION(S): Increased BMI, resident involvement, smoking and perforation of the gallbladder were independently predictors of increased operative duration for laparoscopic cholecystectomy in the outpatient surgical center setting. This data should help improve scheduling accuracy for outpatient surgical centers. Furthermore, this data may be useful in future work, attempting to improve operating room efficiency.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80648
Program Number: P662
Presentation Session: Poster (Non CME)
Presentation Type: Poster
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