title: The cost of surgical training: analysis of operative time for laparoscopic cholecystectomy.
abstract: BACKGROUND
  Duration of surgery is a main cost factor of surgical training. The purpose of this analysis of operative times for laparoscopic cholecystectomies (LC) was to quantify the extra time and related costs in regards to the surgeons' experience in the operating room (OR).
  
  
  METHODS
  All LC performed between January 01, 2005 and December 31, 2008 in 46 hospitals reporting to the database of the Swiss Association for Quality Management in Surgery (AQC) were analyzed (n = 10,010). Four levels of seniority were specified: resident (R), junior consultant (JC), senior consultant (SC), and attending surgeon (AS). The differences in operative time according to seniority were investigated in a multivariable log-linear and median regression analysis controlling for possible confounders. The OR costs were calculated by using a full cost rate in a teaching hospital.
  
  
  RESULTS
  A total of 9,208 LC were available for analysis; 802 had to be excluded due to missing data (n = 212) or secondary major operations (n = 590). Twenty-eight percent of the LC were performed by R as teaching operations (n = 2,591). Compared with R, the multivariable analysis of operative time showed a median difference of -2.5 min (-9.0; 4.8) for JC and -18 min (-25; -11) for SC and -28 min (-35; -10) for AS, respectively. The OR minute costs were <euro>17.57, resulting in incremental costs of <euro>492 (159; 615) per operation in case of tutorial assistance.
  
  
  CONCLUSIONS
  The proportion of LC performed as tutorial assistance for R remains low. Surgical training in the OR causes relevant case-related extra time and therefore costs.
authors.affiliation: Department of Surgery, Basel University Hospital, Spitalstrasse 21, 4031 Basel, Switzerland. mvonstrauss@uhbs.ch
authors.forename: M
authors.initials: M
authors.lastname: von Strauss Und Torney
authors.forename: S
authors.initials: S
authors.lastname: Dell-Kuster
authors.forename: R
authors.initials: R
authors.lastname: Mechera
authors.forename: R
authors.initials: R
authors.lastname: Rosenthal
authors.forename: I
authors.initials: I
authors.lastname: Langer
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000191:economics* / Q000193:education*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time