Association between surgical productivity and start time

Abstract

Background

The objective is to determine the surgical productivity changes between morning and afternoon surgery using the Malmquist index (MI) model. We hypothesized that the late-in-the-day scheduling of surgery significantly reduced the surgical total factor productivity.

Methods

This is a retrospective observational study conducted at a university hospital. 1,463 surgical procedures performed by fifty surgeons were analyzed during the study period of 2023. A non-radial and non-oriented MI model under the variable return-to-scale assumptions was employed. The decision-making unit (DMU) was defined as a surgeon with the highest academic rank in surgery. Inputs were defined as (1) the number of medical doctors who assisted surgery, and (2) the duration of surgical operation from skin incision to closure. The output was defined as the surgical fee for each surgery. Surgical procedures that started between 8 and 11 am were defined as morning surgery, and those that started between 2 and 5 pm were afternoon surgery. The authors added all the inputs and outputs for each DMU during morning and afternoon surgery. The primary outcome measure is MI index, and the secondary outcome measures are the catch-up and frontier-shift effects.

Results

The productivity change from the morning to the afternoon of all surgical procedures was significantly negative. The catch-up effect was not significantly different from zero, while the frontier-shift effect significantly negative.

Conclusions

The surgeons were less productive in the afternoon than in the morning. This productivity regress was likely to be due to reduced availability of hospital resources.

Trial Registration

None.