title: Teaching surgery takes time: the impact of surgical education on time in the operating room.
abstract: BACKGROUND
  It is generally accepted that surgical training is associated with increased surgical duration. The purpose of this study was to determine the magnitude of this increase for common surgical procedures by comparing surgery duration in teaching and nonteaching hospitals.
  
  
  METHODS
  This retrospective population-based cohort study included all adult residents of Ontario, Canada, who underwent 1 of 14 surgical procedures between 2002 and 2012. We used several linked administrative databases to identify the study cohort in addition to patient-, surgeon- and procedure-related variables. We determined surgery duration using anesthesiology billing records. Negative binomial regression was used to model the association between teaching versus nonteaching hospital status and surgery duration.
  
  
  RESULTS
  Of the 713 573 surgical cases included in this study, 20.8% were performed in a teaching hospital. For each procedure, the mean surgery duration was significantly longer for teaching hospitals, with differences ranging from 5 to 62 minutes across individual procedures in unadjusted analyses (all p < 0.001). In regression analysis, procedures performed in teaching hospitals were associated with an overall 22% (95% confidence interval 20%-24%) increase in surgery duration, adjusting for patient-, surgeon- and procedure-related variables as well as the clustering of patients within surgeons and hospitals.
  
  
  CONCLUSIONS
  Our results show that a wide range of surgical procedures require significantly more time to perform in teaching than nonteaching hospitals. Given the magnitude of this difference, the impact of surgical training on health care costs and clinical outcomes should be a priority for future studies.
authors.affiliation: From the Department of Surgery, Divisions of General Surgery (Vinden), Thoracic Surgery (Malthaner), Urology (Welk) and Vascular Surgery (Dubois), and the Department of Obstetrics and Gynaecology (McGee), Western University, London, Ont.; and the Institute for Clinical Evaluative Sciences, Toronto, Ont. (Vinden, McClure, Winick-Ng, Liu, Nash, Welk).
authors.forename: Christopher
authors.initials: C
authors.lastname: Vinden
authors.affiliation: From the Department of Surgery, Divisions of General Surgery (Vinden), Thoracic Surgery (Malthaner), Urology (Welk) and Vascular Surgery (Dubois), and the Department of Obstetrics and Gynaecology (McGee), Western University, London, Ont.; and the Institute for Clinical Evaluative Sciences, Toronto, Ont. (Vinden, McClure, Winick-Ng, Liu, Nash, Welk).
authors.forename: Richard
authors.initials: R
authors.lastname: Malthaner
authors.affiliation: From the Department of Surgery, Divisions of General Surgery (Vinden), Thoracic Surgery (Malthaner), Urology (Welk) and Vascular Surgery (Dubois), and the Department of Obstetrics and Gynaecology (McGee), Western University, London, Ont.; and the Institute for Clinical Evaluative Sciences, Toronto, Ont. (Vinden, McClure, Winick-Ng, Liu, Nash, Welk).
authors.forename: Jacob
authors.initials: J
authors.lastname: McGee
authors.affiliation: From the Department of Surgery, Divisions of General Surgery (Vinden), Thoracic Surgery (Malthaner), Urology (Welk) and Vascular Surgery (Dubois), and the Department of Obstetrics and Gynaecology (McGee), Western University, London, Ont.; and the Institute for Clinical Evaluative Sciences, Toronto, Ont. (Vinden, McClure, Winick-Ng, Liu, Nash, Welk).
authors.forename: J Andrew
authors.initials: JA
authors.lastname: McClure
authors.affiliation: From the Department of Surgery, Divisions of General Surgery (Vinden), Thoracic Surgery (Malthaner), Urology (Welk) and Vascular Surgery (Dubois), and the Department of Obstetrics and Gynaecology (McGee), Western University, London, Ont.; and the Institute for Clinical Evaluative Sciences, Toronto, Ont. (Vinden, McClure, Winick-Ng, Liu, Nash, Welk).
authors.forename: Jennifer
authors.initials: J
authors.lastname: Winick-Ng
authors.affiliation: From the Department of Surgery, Divisions of General Surgery (Vinden), Thoracic Surgery (Malthaner), Urology (Welk) and Vascular Surgery (Dubois), and the Department of Obstetrics and Gynaecology (McGee), Western University, London, Ont.; and the Institute for Clinical Evaluative Sciences, Toronto, Ont. (Vinden, McClure, Winick-Ng, Liu, Nash, Welk).
authors.forename: Kuan
authors.initials: K
authors.lastname: Liu
authors.affiliation: From the Department of Surgery, Divisions of General Surgery (Vinden), Thoracic Surgery (Malthaner), Urology (Welk) and Vascular Surgery (Dubois), and the Department of Obstetrics and Gynaecology (McGee), Western University, London, Ont.; and the Institute for Clinical Evaluative Sciences, Toronto, Ont. (Vinden, McClure, Winick-Ng, Liu, Nash, Welk).
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Nash
authors.affiliation: From the Department of Surgery, Divisions of General Surgery (Vinden), Thoracic Surgery (Malthaner), Urology (Welk) and Vascular Surgery (Dubois), and the Department of Obstetrics and Gynaecology (McGee), Western University, London, Ont.; and the Institute for Clinical Evaluative Sciences, Toronto, Ont. (Vinden, McClure, Winick-Ng, Liu, Nash, Welk).
authors.forename: Blayne
authors.initials: B
authors.lastname: Welk
authors.affiliation: From the Department of Surgery, Divisions of General Surgery (Vinden), Thoracic Surgery (Malthaner), Urology (Welk) and Vascular Surgery (Dubois), and the Department of Obstetrics and Gynaecology (McGee), Western University, London, Ont.; and the Institute for Clinical Evaluative Sciences, Toronto, Ont. (Vinden, McClure, Winick-Ng, Liu, Nash, Welk).
authors.forename: Luc
authors.initials: L
authors.lastname: Dubois
mesh_terms: D000328:Adult; D013502:General Surgery / Q000193:education*; D006784:Hospitals, Teaching; D006801:Humans; D015233:Models, Statistical; D009864:Ontario; D009873:Operating Rooms; D061646:Operative Time; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000193:education / Q000706:statistics & numerical data*