title: Impact of resident surgeons on procedure length based on common pediatric otolaryngology cases.
abstract: OBJECTIVE
  Surgical education remains an important mission of academic medical centers. Financial pressures may favor improved operating room (OR) efficiency at the expense of teaching in the OR. We aim to evaluate factors, such as resident participation, associated with duration of total OR, as well as procedural time of common pediatric otolaryngologic cases.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  We reviewed resident and attending surgeon total OR and procedural times for isolated tonsillectomy, adenoidectomy, tonsillectomy with adenoidectomy (T&A), and bilateral myringotomy with tube insertion between 2009 and 2013. We included cases supervised or performed by one of four teaching surgeons in children with American Society of Anesthesiology classification < 3. Regression analyses were used to identify predictors of procedural time.
  
  
  RESULTS
  We identified 3,922 procedures. Residents had significantly longer procedure times for all procedures compared to an attending surgeon (4.9-12.8 minutes, P < 0.001). Differences were proportional to case complexity. In T&A patients, older patient age and attending surgeon identity were also significant predictors of increased mean procedural time (P < 0.05).
  
  
  CONCLUSIONS
  Resident participation contributes to increased procedure time for common otolaryngology procedures. We found that differences in operative time between resident surgeons and attending surgeons are proportional to the complexity of the case, with additional factors, such as attending surgeon identity and older patient age, also influencing procedure times. Despite the increased procedural time, our investigation shows that resident education does not result in excessive operative times beyond what may be reasonably expected at a teaching institution.
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Sidharth V
authors.initials: SV
authors.lastname: Puram
authors.forename: Elliott D
authors.initials: ED
authors.lastname: Kozin
authors.forename: Rosh
authors.initials: R
authors.lastname: Sethi
authors.forename: Blake
authors.initials: B
authors.lastname: Alkire
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Lee
authors.forename: Stacey T
authors.initials: ST
authors.lastname: Gray
authors.forename: Mark G
authors.initials: MG
authors.lastname: Shrime
authors.forename: Michael
authors.initials: M
authors.lastname: Cohen
mesh_terms: D000046:Academic Medical Centers / Q000191:economics; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004503:Education, Medical, Graduate / Q000191:economics; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008505:Medical Staff, Hospital; D015999:Multivariate Analysis; D009873:Operating Rooms / Q000191:economics / Q000706:statistics & numerical data*; D061646:Operative Time; D010036:Otolaryngology / Q000193:education; D013517:Otorhinolaryngologic Surgical Procedures / Q000193:education* / Q000379:methods*; D010372:Pediatrics; D012189:Retrospective Studies; D013997:Time Factors
keywords: cost; education; operative time; procedure length; residency; training