Early endocrine attending surgeon presence increases operating room efficiency.
Preincision operating room (OR) preparation varies greatly. Cases requiring exacting preoperative setup may be more sensitive to inconsistent team members and trainees. Leadership and oversight by the surgeon may facilitate a timely start. The study hypothesized that early attending presence in the OR expedites surgery start time, improving efficiency, and decreasing cost.



Prospective data collection of endocrine surgery cases at an urban teaching hospital was performed. Time points recorded in minutes. Cost/min of OR time was $54. Patients classified as in the OR ≤10 min before attending arrival or >10 min before attending arrival.



A total of 227 cases (166 thyroid, 54 parathyroid, 10 adrenal) were performed over 14 mo. Of the patients, 128 were in the OR ≤10 min before attending arrival, and 99 patients were >10 min (3 ± 3 min versus 35 ± 14 min, P < 0.01). The ≤10 min procedures started sooner after patient arrival in OR (40 ± 11 versus 63 ± 19, P < 0.01) which equated to $1202 of savings before incision. Although attending time in the OR before incision was equivalent between groups for adrenal and parathyroid, time to incision was shorter in the ≤10 min groups, saving $2416 ± 477 and $1458 ± 244, respectively (P < 0.01). Attending time in OR before thyroidectomy was 13 min longer in ≤10 min than >10 min (P < 0.01), but incisions were made 20 min sooner (P < 0.01) equating to $1076 ± 120 in savings.



Early attending presence in the OR shortens time to incision. For parathyroid and adrenal cases, this does not require additional surgeon time. In ORs without consistent teams, early attending presence in the OR improves efficiency and yields significant cost savings.
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Audra
A
Clark
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Alan P
AP
Dackiw
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Wendy D
WD
White
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Fiemu E
FE
Nwariaku
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Shelby A
SA
Holt
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Jennifer L
JL
Rabaglia
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: Sarah.Oltmann@utsouthwestern.edu.
Sarah C
SC
Oltmann
D000328:Adult; D000368:Aged; D017598:Efficiency, Organizational; D013507:Endocrine Surgical Procedures; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D007857:Leadership; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000458:organization & administration*; D061646:Operative Time; D012189:Retrospective Studies; D066231:Surgeons / Q000458:organization & administration*; D013781:Texas
Cost savings; Delay reduction; Operating room efficiency; Surgeon leadership; Teamwork; Utilization