Abstract

OBJECTIVES: Decreasing variability in time intensive tasks during cardiac surgery may reduce total procedural time, lower costs, reduce clinician burnout, and improve patient access. The relative contribution and variability of surgeon and anesthesia control times to total procedural time is unknown.METHODS: 669 patients undergoing coronary artery bypass graft surgery were enrolled. Using linear regression, we estimated adjusted surgeon and anesthesia control times controlling for patient and procedural covariates. The primary end point compared overall surgeon and anesthesia control times. The secondary end point compared the variability in adjusted surgeon and anesthesiologist control times. Sensitivity analyses quantified the relative importance of the specific surgeon and anesthesiologist in the adjusted linear models.RESULTS: The median surgeon control time was 4.1 hours (interquartile range: 3.4 to 4.9 hours) compared to a median anesthesia control time of 1.0 hours (interquartile range: 0.8 to 1.2 hours, p < 0.001). Using linear regression, the variability in adjusted surgeon control time amongst surgeons (range: 1.8 hours) was 3.5-fold greater than the variability in adjusted anesthesia control time amongst anesthesiologists (range: 0.5 hours, p < 0.001). The specific surgeon and anesthesiologist accounted for 50% of the explanatory power of the predictive model (p < 0.001).CONCLUSIONS: Surgeon control time variability is significantly greater than anesthesia control time variability and strongly associated with the surgeon performing the procedure. While these results suggest surgeon control time variability is an attractive operational target, further studies are needed to determine practitioner specific and modifiable attributes to reduce variability and improve efficiency.

View details for DOI 10.1016/j.jtcvs.2023.08.011

View details for PubMedID 37574007