Surgeon Factors and Their Association With Operating Room Turnover Time

Abstract

Introduction Operating room (OR) turnover time (TT), defined as the interval between the completion of one surgery and the start of the next, is a critical measure of OR efficiency impacting healthcare costs, patient outcomes, and surgical staff well-being. Previous research has identified various contributors to TT, such as surgical team dynamics, OR preparation, and interdisciplinary workflows. However, the influence of surgeon-specific factors like gender, administrative roles, and experience on TT remains underexplored. This study aims to address this gap by examining how these individual surgeon characteristics impact OR efficiency. Methods We conducted a retrospective study at the UC San Diego School of Medicine, a tertiary academic medical center. We analysed 12,820 surgical case entries from January 2022 to July 2023, sourced from the electronic health record system. Surgeons were categorized by gender, ethnicity, years of experience, training at UCSD, academic rank, and administrative roles (Table 1). Data on turnover time (TT) were calculated by summing six components: wrap-up time after the first case, wheeling out to clean-up start, clean-up duration, completion of clean-up to the start of second case setup, second case setup, and wheeling in the patient for the second case. Cases exceeding two standard deviations above the mean TT were excluded to remove outliers caused by extraordinary circumstances unrelated to normal surgical workflow. Surgeons with less than 3 recorded case entries were also excluded to ensure a reliable representation. We utilized Mann-Whitney U test for binary variables and Kruskal-Wallis H test for variables with more than two categories. Multivariable linear regression was applied, adjusting for multiple comparisons using Holm correction. A p-value of less than 0.05 was considered statistically significant. All data analysis was performed using IBM SPSS version 29. Results: Our analysis of 12,820 surgical cases revealed that surgeons in administrative roles and those with over ten years of experience demonstrated significantly shorter turnover times (TT). Specifically, administrators demonstrated a TT of 27 minutes, compared to 35 minutes for non-administrators (p<0.001) (Table 2). Surgeons with more than ten years of experience had a TT of 31 minutes, versus 37 minutes for those with less experience (p<0.001). Multivariable linear regression confirmed these associations, with significant reductions in TT linked to administrative roles (beta: -7.2; 95% confidence interval (CI): -8.2 to -6.2, p<0.001) and surgeon experience (beta: -4.7, 95% CI: -5.9 to -3.5, p< 0.001). Conclusion: We recommend efforts focusing on building a standardized environment for surgeons regardless of their background. This could lead to not only an equitable OR culture but also an overall increase in the institution efficiency and patient outcomes.