Operating Room Times For Teaching and Nonteaching Cases are Converging: Less Time for Learning?

OBJECTIVE: To compare differences in operating room (OR) times between teaching and nonteaching cases across calendar years. We hypothesize that time devoted to intraoperative resident education is decreasing, therefore, OR times for teaching and nonteaching cases will be converging. BACKGROUND: Teaching cases take longer than similar nonteaching cases, in part due to intraoperative resident education. Pressures to improve OR efficiency and patient safety may threaten resident education and leave less time for intraoperative learning; however, the magnitude of impact is unknown. SETTING/PARTICIPANTS: National Surgical Quality Improvement Program (NSQIP) deidentified national databases from 2006 to 2012, queried for 30 most common General surgery procedures and case teaching status (i.e., teaching vs. nonteaching cases). DESIGN: The NSQIP database was retrospectively reviewed to identify the 30 most common General Surgery procedures. Teaching cases included all operations in which a resident participated. Multivariable regression analyses were constructed to determine the impact of resident involvement on OR times, controlling for year, resident participation, procedure, and patient demographics and comorbidities. Difference-in-difference analysis was performed to assess OR time differences between teaching and nonteaching cases across calendar years and within subpopulations. RESULTS: A total of 693,223 cases met inclusion criteria. Average overall OR times were 98.89 minutes (teaching) vs. 74.22 minutes (nonteaching), with a difference of 24.67 minutes (95% confidence interval [CI] 24.34-24.99 minutes, p < 0.001). In multivariable analyses, the difference between teaching and nonteaching cases was 21.94 minutes (95% CI = 21.11-22.76) in 2006 and 13.95 minutes (95% CI = 10.62-17.28) in 2012, with a difference-in-difference of 7.99 minutes per case. A similar trend was observed across individual PGYs and several individual procedures. CONCLUSIONS: OR times for teaching and nonteaching cases converged by approximately 8 minutes per general surgery procedure during the 7-year study period, representing a 36% reduction in the difference between groups. We must seek to better understand the source of this convergence, and in doing so ensure to preserve and enhance the intraoperative learning experience of surgical trainees.