title: Effect of Resident Involvement on Operative Time and Operating Room Staffing Costs.
abstract: OBJECTIVE
  The operating room (OR) is a major driver of hospital costs; therefore, operative time is an expensive resource. The training of surgical residents must include time spent in the OR, but that experience comes with a cost to the surgeon and hospital. The objective of this article is to determine the effect of surgical resident involvement in the OR on operative time and subsequent hospital labor costs.
  
  
  METHODS
  The Kruskal-Wallis statistical test is used to determine whether or not there is a difference in operative times between 2 groups of cases (with residents and without residents). This difference leads to an increased cost in associated hospital labor costs for the group with the longer operative time.
  
  
  METHODS
  Cases were performed at Greenville Memorial Hospital. Greenville Memorial Hospital is part of the larger healthcare system, Greenville Health System, located in Greenville, SC and is a level 1 trauma center with up to 33 staffed ORs.
  
  
  METHODS
  A total of 84,997 cases were performed at the partnering hospital between January 1st, 2011 and July 31st, 2015. Cases were only chosen for analysis if there was only one CPT code associated with the case and there were more than 5 observations for each group being studied. This article presents a comprehensive retrospective analysis of 29,134 cases covering 246 procedures.
  
  
  RESULTS
  The analysis shows that 45 procedures took significantly longer with a resident present in the room. The average increase in operative time was 4.8 minutes and the cost per minute of extra operative time was determined to be $9.57 per minute. OR labor costs at the partnering hospital was found to be $2,257,433, or $492,889 per year.
  
  
  CONCLUSIONS
  Knowing the affect on operative time and OR costs allows managers to make smart decisions when considering alternative educational and training techniques. In addition, knowing the connection between residents in the room and surgical duration could help provide better estimates of surgical time in the future and increase the predictability of procedure duration.
authors.affiliation: School of Health Research, Clemson University, Clemson, South Carolina. Electronic address: rallen3@g.clemson.edu.
authors.forename: Robert William
authors.initials: RW
authors.lastname: Allen
authors.affiliation: Anesthesiology, Greenville Health System, Greenville, South Carolina.
authors.forename: Mark
authors.initials: M
authors.lastname: Pruitt
authors.affiliation: Industrial Engineering, Clemson University, Clemson, South Carolina.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Taaffe
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004503:Education, Medical, Graduate / Q000191:economics / Q000379:methods; D005260:Female; D013502:General Surgery / Q000193:education*; D017721:Hospital Costs; D006801:Humans; D007396:Internship and Residency / Q000191:economics* / Q000379:methods; D008297:Male; D009873:Operating Rooms / Q000191:economics* / Q000458:organization & administration; D010348:Patient Care Team / Q000191:economics*; D012016:Reference Values; D012189:Retrospective Studies; D014481:United States
keywords: Medical Knowledge; Professionalism; Systems-Based Practice; operative time; staffing costs; surgical resident; training