Presentation Authors: Zaeem Lone, Ahmed S. Elsayed, Naif A. Aldhaam*, Jacob Braun, Rocco Corbisiero, Brett Hull, Sarah Khan, Zhe Jing, Paul May, Gaybrielle B James, Eric Kauffman, James L. Mohler, Khurshid A. Guru, Buffalo, NY
Introduction: The operating room (OR) is considered one of the main cost drivers within hospitals as well as a major source of revenue. Variability in OR time can lead to inadequate utilization of the available space. Evidence suggests that the surgeon is a major source of variability in operative times. Therefore the aim of the study was to develop a model to evaluate factors that impact operative time during robot-assisted radical prostatectomy (RARP).
Methods: A retrospective study was conducted at our institution from 2005-2017 utilizing data from a prospectively maintained prostate cancer database. Our model included preoperative variables like institutional volume from four surgeons, the surgeon performing the procedure, BMI, American Society of Anesthesiologists Score, prostate weight, nerve-sparing status, extent of lymph node dissection. A binary decision tree was fit using conditional interference method to predict operative times. The variable most associated with operative time was determined using permutation tests. Data were split at the value of the variable that results in the largest difference in mean surgical time across the split. The process was repeated recursively on the resultant data.
Results: 1296 procedures were included to develop the model. The variable most strongly associated with the operative time was the surgeon performing the procedure (surgeons 2-4 were 94 minutes on average longer than surgeon 1, p < 0.001). Among surgeons 2-4, the type of lymph node dissection (bilateral, unilateral or none) was most strongly associated with overall surgical time (p < 0.001). Depending on whether lymph node dissection was performed, the next major predictor among this cohort was the surgeon performing the procedure. Surgeon 2 was 45 min longer than surgeons 3 and 4 (p < 0.001). For surgeon 1, BMI > 30 was most strongly associated with higher surgical time (p < 0.001). After BMI, the second major predictor of operative time for this lone surgeon was the type of lymph node dissection, bilateral, unilateral, or none (p < 0.001).
Conclusions: Variation in operative times for RARP is largely driven by the surgeon performing the procedure. Understanding how surgeon variation effects operative times could lead to better patient flow and scheduling in the OR.
Source of Funding: Roswell Park Alliance Foundation