Presentation Authors: Matthew Winter, Akbar Ashrafi, Hannah Landsberger, Shane Pearce, Giovanni Cacciamani, Carey Li, Luis Medina, Aliasger Shakir*, Andre Berger, Andre Abreu, Mihir Desai, Inderbir Gill, Monish Aron, Los Angeles, CA
Introduction: The total time the attending surgeon (AS) is present in the operating room (OR) during a surgical case may impact patient outcomes and overall cost. Current literature supports senior surgical trainees independently performing procedures with equivalent outcomes. The aim of this study is to determine if the time the AS spends in the OR during minimally invasive surgery (MIS) urological procedures correlates with peri-operative outcomes and variable cost.
Methods: Our prospectively collated institutional review board approved database and the institutional financial accounting system were used to identify all patients undergoing six common MIS urological procedures during the 2016-2017 fiscal year. The time the AS spent in the OR for each case was prospectively collected and converted into the percentage of time from first incision to closure of skin. The patient cohort was divided into two groups based on the median time the AS spent in the OR for each procedure type: the lower group (LG) and the upper group (UG). The primary outcome of interest was operating time (OT) and total variable cost. Secondary outcomes included length of stay (LOS), estimated blood loss (EBL) and prostatectomy T2 positive surgical margins (PSMs).
Results: A total of 804 MIS procedures were identified. Overall, the median percentage time the AS was present in the OR was 77% (Table 1). The ASA, variable cost ($12,382 v $12,431, p=0.97), EBL (100 v 150 mL, p=0.16) and ICU stay (0.3 v 0.2 days, p=0.32) did not differ between UG and LG respectively. The UG was associated with a shorter OT (225 vs 244min, p < 0.01) and longer LOS (2.8 v 2.2days, p=0.02). Sub-group analysis of robotic prostatectomy revealed that the UG was associated with a shorter OT (222 v 242min, p=0.01) and lower variable cost ($10,709 v $11,355, p < 0.01) with no difference EBL (100 v 100 mL, p=0.16), LOS (2.8 v 2.7 days, p=0.17) or T2 PSMs (9.9 v 6.2%, p=0.45) between groups.
Conclusions: The total time the AS is present in the OR during common MIS urological procedures reduces the total operating time without negatively influence EBL, LOS, or total variable cost.