title: Operative time and cost of resident surgical experience: effect of instituting an otolaryngology residency program.
abstract: OBJECTIVE
  Describe the procedure length difference between surgeries performed by an attending surgeon alone compared with the resident surgeon supervised by the same attending surgeon.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary care center and residency program.
  
  
  METHODS
  Six common otolaryngologic procedures performed between August 1994 and May 2012 were divided into 2 cohorts: attending surgeon alone or resident surgeon. This division coincided with our July 2006 initiation of an otolaryngology-head and neck surgery residency program. Operative duration was compared between cohorts with confounding factors controlled. In addition, the direct result of increased surgical length on operating room cost was calculated and applied to departmental and published resident case log report data.
  
  
  RESULTS
  Five of the 6 procedures evaluated showed a statistically significant increase in surgery length with resident involvement. Operative time increased 6.8 minutes for a cricopharyngeal myotomy (P = .0097), 11.3 minutes for a tonsillectomy (P < .0001), 27.4 minutes for a parotidectomy (P = .028), 38.3 minutes for a septoplasty (P < .0001), and 51 minutes for tympanomastoidectomy (P < .0021). Thyroidectomy showed no operative time difference. Cost of increased surgical time was calculated per surgery and ranged from $286 (cricopharyngeal myotomy) to $2142 (mastoidectomy). When applied to reported national case log averages for graduating residents, this resulted in a significant increase of direct training-related costs.
  
  
  CONCLUSIONS
  Resident participation in the operating room results in increased surgical length and additional system cost. Although residency is a necessary part of surgical training, associated costs need to be acknowledged.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Phoenix, Arizona 85054, USA. pollei.taylor@mayo.edu
authors.forename: Taylor R
authors.initials: TR
authors.lastname: Pollei
authors.forename: David M
authors.initials: DM
authors.lastname: Barrs
authors.forename: Michael L
authors.initials: ML
authors.lastname: Hinni
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Bansberg
authors.forename: Logan C
authors.initials: LC
authors.lastname: Walter
mesh_terms: D002983:Clinical Competence / Q000191:economics; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D004503:Education, Medical, Graduate / Q000191:economics* / Q000379:methods; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007396:Internship and Residency / Q000191:economics* / Q000379:methods; D008297:Male; D009873:Operating Rooms / Q000191:economics; D061646:Operative Time; D010036:Otolaryngology / Q000191:economics / Q000193:education*; D013517:Otorhinolaryngologic Surgical Procedures / Q000191:economics* / Q000379:methods; D012189:Retrospective Studies; D014481:United States
keywords: cost; operative time; otolaryngology; procedure length; residency; resident; training