title: Microcomplications in laparoscopic cholecystectomy: impact on duration of surgery and costs.
abstract: In the era of cost-constrained health care, optimal resource utilisation becomes fundamental in daily clinical practice. Currently, processes during surgery are poorly defined and workflows need to be scrutinised. This investigation aimed at identifying interruptions of surgical workflow and quantifying their impact on the duration of surgery and costs.
  
  
  
  Interruptions of surgical workflow were defined as microcomplications (MC) and divided into the following subgroups: communication-related (CR), instrument changes (IC), missing instruments (MI), instrument failure (IF), waiting for a senior surgeon (SS), anaesthesia-related (AR) and position changes (PC). Audio-video records of laparoscopic cholecystectomies were reviewed regarding type, frequency and duration of MC. Risk factors for MC were investigated in a multivariable linear regression analysis. The costs of MC due to intraoperative delay were calculated.
  
  
  
  Twenty audio-video records of laparoscopic cholecystectomies with a total duration of 28.9 h were reviewed. The median frequency of MC was 95 events/h with an overall duration of 452 min, corresponding to a delay of 15.6 min/h. Most frequent causes for MC were CR (32 events/h) and IC (54 events/h), leading to a total delay of 6.5 min/h for CR and 4.5 min/h for IC, respectively. MI and IF were less frequent (2.0 and 5.4 events/h), but single events lasted longer, resulting in a total delay of 1.4 min/h in MI and 2.1 min/h in IF. Intraoperative delays due to SS, AR or PC were rare. Multivariable regression analysis revealed previous abdominal surgery and cholecystitis as risk factors for a longer duration of MC (p = 0.004; p = 0.046). Based on OR minute costs of € 31.98, the delay due to MC led to additional costs of € 499/h.
  
  
  
  MC cause relevant intraoperative delay and increased costs. Step-by-step protocols for a laparoscopic cholecystectomy may lead to a reduction in MC and should be further evaluated.
authors: Department of Surgery, University Hospital Basel, Basel, Switzerland. marco.vonstrauss@ksa.ch.|Department of Surgery, Cantonal Hospital Aarau, 5001, Aarau, Switzerland. marco.vonstrauss@ksa.ch.
authors: Marco
authors: M
authors: von Strauss Und Torney
authors: Department of Surgery, University Hospital Basel, Basel, Switzerland.|Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland.
authors: Salome
authors: S
authors: Dell-Kuster
authors: Department of Surgery, University Hospital Basel, Basel, Switzerland.
authors: Henry
authors: H
authors: Hoffmann
authors: Department of Surgery, University Hospital Basel, Basel, Switzerland.|Indiana University School of Medicine South Bend, Indiana University Health Goshen Center for Cancer Care, Goshen, IN, USA.
authors: Urs
authors: U
authors: von Holzen
authors: Department of Surgery, University Hospital Basel, Basel, Switzerland.
authors: Daniel
authors: D
authors: Oertli
authors: Department of Surgery, University Hospital Basel, Basel, Switzerland.
authors: Rachel
authors: R
authors: Rosenthal
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic; D003142:Communication; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000458:organization & administration*; D013525:Surgical Instruments; D057188:Workflow
keywords: Costs; Disruption; Duration of surgery; Intraoperative delay; Laparoscopic cholecystectomy; Workflow