Does surgeon workload per day affect outcomes after pulmonary lobectomies?
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.
Division of General Thoracic Surgery, Mayo Clinic Rochester, Rochester, Minnesota 55905, USA.
Mathew
M
Thomas
Mark S
MS
Allen
Dennis A
DA
Wigle
K Robert
KR
Shen
Stephen D
SD
Cassivi
Francis C
FC
Nichols
Claude
C
Deschamps
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011013:Pneumonectomy / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States; D016526:Workload / Q000706:statistics & numerical data*; D055815:Young Adult