title: The use of patient factors to improve the prediction of operative duration using laparoscopic cholecystectomy.
abstract: Reliable prediction of operative duration is essential for improving patient and care team satisfaction, optimizing resource utilization and reducing cost. Current operative scheduling systems are unreliable and contribute to costly over- and underestimation of operative time. We hypothesized that the inclusion of patient-specific factors would improve the accuracy in predicting operative duration.
  
  
  
  We reviewed all elective laparoscopic cholecystectomies performed at a single institution between 01/2007 and 06/2013. Concurrent procedures were excluded. Univariate analysis evaluated the effect of age, gender, BMI, ASA, laboratory values, smoking, and comorbidities on operative duration. Multivariable linear regression models were constructed using the significant factors (p < 0.05). The patient factors model was compared to the traditional surgical scheduling system estimates, which uses historical surgeon-specific and procedure-specific operative duration. External validation was done using the ACS-NSQIP database (n = 11,842).
  
  
  
  A total of 1801 laparoscopic cholecystectomy patients met inclusion criteria. Female sex was associated with reduced operative duration (-7.5 min, p < 0.001 vs. male sex) while increasing BMI (+5.1 min BMI 25-29.9, +6.9 min BMI 30-34.9, +10.4 min BMI 35-39.9, +17.0 min BMI 40 + , all p < 0.05 vs. normal BMI), increasing ASA (+7.4 min ASA III, +38.3 min ASA IV, all p < 0.01 vs. ASA I), and elevated liver function tests (+7.9 min, p < 0.01 vs. normal) were predictive of increased operative duration on univariate analysis. A model was then constructed using these predictive factors. The traditional surgical scheduling system was poorly predictive of actual operative duration (R2= 0.001) compared to the patient factors model (R2= 0.08). The model remained predictive on external validation (R2= 0.14).The addition of surgeon as a variable in the institutional model further improved predictive ability of the model (R2= 0.18).
  
  
  
  The use of routinely available pre-operative patient factors improves the prediction of operative duration during cholecystectomy.
authors.affiliation: Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.|Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.
authors.forename: Cornelius A
authors.initials: CA
authors.lastname: Thiels
authors.affiliation: Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.|Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.|School of Industrial Engineering, Purdue University, West Lafayette, IN, USA.
authors.forename: Denny
authors.initials: D
authors.lastname: Yu
authors.affiliation: Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.|Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Amro M
authors.initials: AM
authors.lastname: Abdelrahman
authors.affiliation: Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.|Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
authors.affiliation: Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.|Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.|Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Hallbeck
authors.affiliation: Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.|Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Kalyan S
authors.initials: KS
authors.lastname: Pasupathy
authors.affiliation: Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. BingenerCasey.Juliane@mayo.edu.
authors.forename: Juliane
authors.initials: J
authors.lastname: Bingener
mesh_terms: D015992:Body Mass Index; D017081:Cholecystectomy, Laparoscopic; D066264:Datasets as Topic; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D012737:Sex Factors
keywords: Laparoscopic cholecystectomy; NSQIP; Operative duration; Patient factors; Scheduling