Etienne Meunier1, Cécile Payet2,3, Jean-Louis Peix4, Jean-Louis Kraimps5, Fabrice Menegaux6, François Pattou7,8, Fréderic Sebag9, Jean Christophe Lifante3,4, Antoine Duclos2,3. 1. Health Data Centre, Public Health Department, Hospices Civils de Lyon, Lyon, France. etienne.meunier@etu.univ-lyon.fr. 2. Health Data Centre, Public Health Department, Hospices Civils de Lyon, Lyon, France. 3. Health Services and Performance Research Lab (EA 7425 HESPER), Université Claude Bernard Lyon 1, Lyon, France. 4. Service de Chirurgie Générale et Endocrinienne, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, Lyon, France. 5. Department of Endocrine Surgery, Jean Bernard Hospital, Poitiers University, Poitiers, France. 6. Service de Chirurgie Générale, Viscérale et Endocrinienne, Hôpital la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France. 7. Chirurgie Générale et Endocrinienne, Centre Hospitalier Régional Universitaire de Lille, Lille, France. 8. Institut National de la Santé et de la Recherche Médicale (INSERM), Université Lille Nord de France, Lille, France. 9. Chirurgie Générale, Endocrinienne et Métabolique, Centre Hospitalier Universitaire la Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, France.
Abstract
BACKGROUND: Evidence is lacking regarding the potential association between daily variation in individual surgeon's operative time, procedure after procedure, and risk of patient complication. We assumed that surgeon deviation from the expected procedure duration may be harmful for patient. METHOD: All patients who underwent a thyroidectomy undertaken in five hospitals during a 1-year period were included prospectively. For each thyroidectomy, we estimated the expected operative time from a multilevel linear regression considering the attending surgeon who performed the operation, the patient preoperative risk, and the procedure complexity. Three groups of thyroidectomies were identified according to whether the observed duration is: slower than expected, as expected, or faster than expected. Rates of permanent recurrent laryngeal nerve palsy and hypoparathyroidism at 6 months were then compared between these groups. RESULTS: A total of 3102 patients who underwent a thyroidectomy undertaken by 22 surgeons were considered. Risk of laryngeal nerve palsy was higher in the "slow" group than in the "normal" group (OR = 4.63, 95% confidence interval 2.21-9.70), as was that of hypoparathyroidism (OR = 2.43, 95% confidence interval 1.21-4.88). There was no significant difference between "fast" and "normal" groups for either complication. Deviation from expected procedure duration was more frequent at the end than at the beginning of the daily operation schedule (29.4% vs. 18.3%, respectively, P < .001). CONCLUSION: Patients had a greater risk of complication when the surgeon performed thyroidectomy slower than expected. Surgeons avoiding excessive deviations from their expected procedures durations reflect safer practice.
BACKGROUND: Evidence is lacking regarding the potential association between daily variation in individual surgeon's operative time, procedure after procedure, and risk of patient complication. We assumed that surgeon deviation from the expected procedure duration may be harmful for patient. METHOD: All patients who underwent a thyroidectomy undertaken in five hospitals during a 1-year period were included prospectively. For each thyroidectomy, we estimated the expected operative time from a multilevel linear regression considering the attending surgeon who performed the operation, the patient preoperative risk, and the procedure complexity. Three groups of thyroidectomies were identified according to whether the observed duration is: slower than expected, as expected, or faster than expected. Rates of permanent recurrent laryngeal nerve palsy and hypoparathyroidism at 6 months were then compared between these groups. RESULTS: A total of 3102 patients who underwent a thyroidectomy undertaken by 22 surgeons were considered. Risk of laryngeal nerve palsy was higher in the "slow" group than in the "normal" group (OR = 4.63, 95% confidence interval 2.21-9.70), as was that of hypoparathyroidism (OR = 2.43, 95% confidence interval 1.21-4.88). There was no significant difference between "fast" and "normal" groups for either complication. Deviation from expected procedure duration was more frequent at the end than at the beginning of the daily operation schedule (29.4% vs. 18.3%, respectively, P < .001). CONCLUSION:Patients had a greater risk of complication when the surgeon performed thyroidectomy slower than expected. Surgeons avoiding excessive deviations from their expected procedures durations reflect safer practice.
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