Division of Plastic Surgery, Riley Hospital for Children, Indiana University Medical Center, Indianapolis, Indiana.
J Surg Educ. 2013 Sep-Oct;70(5):655-9. doi: 10.1016/j.jsurg.2013.04.008. Epub 2013 May 24.
Within the surgical community, it is commonly accepted that the length and cost of a surgical case increase when a resident physician participates. Many accountable care organizations, however, believe the opposite, that is, resident assistance enhances efficiency and diminishes operative time. The purpose of this study is to determine the opportunity cost to the attending surgeon for intraoperative teaching during index plastic surgery cases.
A single senior surgeon's experience over a 7-year period was evaluated retrospectively for Current Procedural Terminology codes 40700 (repair of primary, unilateral cleft lip) and 42200 (palatoplasty). Variables collected include operative time, the presence or absence of a physician learner, and postgraduate year level. Statistical analysis was performed with the Kruskal-Wallis test using the S+ programming language. A cost analysis was performed to quantify the effect of longer operative times in terms of relative value units (RVUs) lost.
During the study period, a total of 45 patients had primary, unilateral cleft lip repair; 70 patients had cleft palate repair. Of those cases, 39 (87%) cleft lip repairs and 60 (86%) cleft palate repairs were performed with a resident or fellow present. There was a statistically significant difference in the amount of time required to perform either surgery with a physician learner than without, with operative times being 60% (p = 0.020) longer for cleft lip repair and 65% (p = 0.0016) longer for cleft palate repair. The results were further stratified based on level of training, with craniofacial fellows and plastic surgery residents (independent and integrated) compared separately. Cases where a craniofacial fellow was present required the longest operative times: 103% (p = 0.0012) longer for cleft lip repairs and 104% (p < 0.0001) longer for cleft palate repairs when compared with the senior surgeon operating alone. Using the 2011 physician work RVUs for these surgeries and the 2011 Medicare conversion factor for RVUs to dollars, the opportunity cost is over $275 per case per trainee for any physician learner. When craniofacial fellows are analyzed separately, over $440 is invested in intraoperative teaching per case per fellow.
Resident involvement in the operating room is crucial to the education of independent surgeons. This involvement, however, comes at a significant opportunity cost to the attending surgeon. As an incentive to retain academic surgeons and uphold a quality academic environment in the OR, compensation should be offered for intraoperative teaching.
在外科领域，人们普遍认为住院医师参与会增加手术的时间和成本。然而，许多问责制医疗组织认为，住院医师的协助可以提高效率并缩短手术时间。本研究旨在确定主治外科医生在整形手术过程中进行术中教学的机会成本。
回顾性评估了一位高级外科医生在 7 年期间的经验，涉及当前程序术语 (CPT) 代码 40700（修复原发性单侧唇裂）和 42200（腭裂修复术）。收集的变量包括手术时间、是否有医生学习者以及研究生年级。使用 S+编程语言进行 Kruskal-Wallis 检验进行统计分析。进行了成本分析，以量化手术时间延长对相对价值单位 (RVU) 损失的影响。
在研究期间，共有 45 名患者接受了单侧唇裂修复术；70 名患者接受了腭裂修复术。其中，39 例（87%）唇裂修复术和 60 例（86%）腭裂修复术有住院医师或研究员参与。与没有医生学习者相比，进行任何一种手术所需的时间都有统计学意义上的显著差异，唇裂修复术的手术时间延长了 60%（p=0.020），腭裂修复术延长了 65%（p=0.0016）。根据培训水平进一步分层，比较了颅面研究员和整形科住院医师（独立和综合）。有颅面研究员在场的情况下，唇裂修复术的手术时间最长：与高级外科医生单独手术相比，手术时间延长了 103%（p=0.0012），腭裂修复术延长了 104%（p<0.0001）。使用这些手术的 2011 年医师工作 RVU 和 2011 年 Medicare RVU 到美元的转换系数，对于任何医师学习者，每位受训者每例的机会成本超过 275 美元。单独分析颅面研究员时，每位研究员每例手术的术中教学投入超过 440 美元。
住院医师在手术室的参与对于独立外科医生的教育至关重要。然而，这会给主治外科医生带来巨大的机会成本。为了留住学术外科医生并维持手术室中的高质量学术环境，应提供术中教学补偿。
