title: Influence of median surgeon operative duration on adverse outcomes in bariatric surgery.
abstract: BACKGROUND
  Evidence suggests that prolonged operative time adversely affects surgical outcomes. However, whether faster surgeons have better outcomes is unclear, as a surgeon׳s speed could reflect skill and efficiency, but may alternatively reflect haste. This study evaluates whether median surgeon operative time is associated with adverse surgical outcomes after laparoscopic Roux-en-Y gastric bypass.
  
  
  METHODS
  We performed a retrospective cohort study using statewide clinical registry data from the years 2006 to 2012. Surgeons were ranked by their median operative time and grouped into terciles. Multivariable logistic regression with robust standard errors was used to evaluate the influence of median surgeon operative time on 30-day surgical outcomes, adjusting for patient and surgeon characteristics, trainee involvement, concurrent procedures, and the complex interaction between these variables.
  
  
  RESULTS
  A total of 16,344 patients underwent surgery during the study period. Compared to surgeons in the fastest tercile, slow surgeons required 53 additional minutes to complete a gastric bypass procedure (median [interquartile range] 139 [133-150] versus 86 [69-91], P<.001). After adjustment for patient characteristic only, slow surgeons had significantly higher adjusted rates of any complication, prolonged length of stay, emergency department visits or readmissions, and venous thromboembolism (VTE). After further adjustment for surgeon characteristics, resident involvement, and the interaction between these variables, slow surgeons had higher rates of any complication (10.5% versus 7.1%, P=.039), prolonged length of stay (14.0% versus 4.4%, P=.002), and VTE (0.39% versus .22%, P<.001).
  
  
  CONCLUSIONS
  Median surgeon operative duration is independently associated with adjusted rates of certain adverse outcomes after laparoscopic Roux-en-Y gastric bypass. Improving surgeon efficiency while operating may reduce operative time and improve the safety of bariatric surgery.
authors: Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan. Electronic address: breames@umich.edu.
authors: Bradley N
authors: BN
authors: Reames
authors: Oakwood Hospital and Medical Center, Dearborn, Michigan.
authors: Daniel
authors: D
authors: Bacal
authors: Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
authors: Robert W
authors: RW
authors: Krell
authors: Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
authors: John D
authors: JD
authors: Birkmeyer
authors: Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
authors: Nancy J O
authors: NJ
authors: Birkmeyer
authors: Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
authors: Jonathan F
authors: JF
authors: Finks
mesh_terms: D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D061646:Operative Time; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000453:epidemiology
keywords: Bariatric surgery; Laparoscopic Roux-en-Y gastric bypass; Outcomes research; Postoperative complications; Quality of care