title: The impact of teaching on the duration of common urological operations.
abstract: BACKGROUND
  The ability of academic (teaching) hospitals to offer the same level of efficiency as non-teaching hospitals in a publicly funded healthcare system is unknown. Our objective was to compare the operative duration of general urology procedures between teaching and non-teaching hospitals.
  
  
  METHODS
  We used administrative data from the province of Ontario to conduct a retrospective cohort study of all adults who underwent a specified elective urology procedure (2002-2013). Primary outcome was duration of surgical procedure. Primary exposure was hospital type (academic or non-teaching). Negative binomial regression was used to adjust relative time estimates for age, comorbidity, obesity, anesthetic, and surgeon and hospital case volume.
  
  
  RESULTS
  114 225 procedures were included (circumcision n=12 280; hydrocelectomy n=7221; open radical prostatectomy n=22 951; transurethral prostatectomy n=56 066; or mid-urethral sling n=15 707). These procedures were performed in an academic hospital in 14.8%, 13.3%, 28.6%, 17.1%, and 21.3% of cases, respectively. The mean operative duration across all procedures was higher in academic centres; the additional operative time ranged from 8.3 minutes (circumcision) to 29.2 minutes (radical prostatectomy). In adjusted analysis, patients treated in academic hospitals were still found to have procedures that were significantly longer (by 10-21%). These results were similar in sensitivity analyses that accounted for the potential effect of more complex patients being referred to tertiary academic centres.
  
  
  CONCLUSIONS
  Five common general urology operations take significantly longer to perform in academic hospitals. The reason for this may be due to the combined effect of teaching students and residents or due to inherent systematic inefficiencies within large academic hospitals.
authors.affiliation: University of Western Ontario, London, ON, Canada;; Institute for Clinical Evaluative Sciences, London, ON, Canada.
authors.forename: Blayne
authors.initials: B
authors.lastname: Welk
authors.affiliation: Institute for Clinical Evaluative Sciences, London, ON, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Winick-Ng
authors.affiliation: Institute for Clinical Evaluative Sciences, London, ON, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: McClure
authors.affiliation: University of Western Ontario, London, ON, Canada;; Institute for Clinical Evaluative Sciences, London, ON, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Vinden
authors.affiliation: University of Western Ontario, London, ON, Canada.
authors.forename: Sumit
authors.initials: S
authors.lastname: Dave
authors.affiliation: University of Western Ontario, London, ON, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Pautler