Variability and relative contribution of surgeon- and anesthesia-specific time components to total procedural time in cardiac surgery

Matthew William Vanneman; Melan Thuraiappah; Igor Feinstein; Vikram Fielding-Singh; Ashley Peterson; Scott Kronenberg; Martin S Angst; Nima Aghaeepour

doi:10.1016/j.jtcvs.2023.08.011

Variability and relative contribution of surgeon- and anesthesia-specific time components to total procedural time in cardiac surgery

J Thorac Cardiovasc Surg. 2023 Aug 12:S0022-5223(23)00676-1. doi: 10.1016/j.jtcvs.2023.08.011. Online ahead of print.

Authors

Matthew William Vanneman¹, Melan Thuraiappah², Igor Feinstein², Vikram Fielding-Singh², Ashley Peterson², Scott Kronenberg³, Martin S Angst², Nima Aghaeepour⁴

Affiliations

¹ Division of Cardiovascular & Thoracic Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, Calif. Electronic address: mwvanneman@stanford.edu.
² Division of Cardiovascular & Thoracic Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, Calif.
³ Department of Cardiovascular Health Quality, Stanford Healthcare, Stanford, Calif.
⁴ Division of Cardiovascular & Thoracic Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, Calif; Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif.

PMID: 37574007
PMCID: PMC10859543 (available on 2025-02-12)
DOI: 10.1016/j.jtcvs.2023.08.011

Abstract

Background: 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 control time (SCT) and anesthesia control time (ACT) to total procedural time is unknown.

Methods: A total of 669 patients undergoing coronary artery bypass graft (CABG) surgery were enrolled. Using linear regression, we estimated adjusted SCTs and ACTs, controlling for patient and procedural covariates. The primary endpoint compared overall SCTs and ACTs. The secondary endpoint compared the variability in adjusted SCTs and ACTs. Sensitivity analyses quantified the relative importance of the specific surgeon and anesthesiologist in the adjusted linear models.

Results: The median SCT was 4.1 hours (interquartile range [IQR], 3.4-4.9 hours) compared to a median ACT of 1.0 hours (IQR, 0.8-1.2 hours; P < .001). Using linear regression, the variability in adjusted SCT among surgeons (range, 1.8 hours) was 3.5-fold greater than the variability in adjusted ACT among anesthesiologists (range, 0.5 hour; P < .001). The specific surgeon and anesthesiologist accounted for 50% of the explanatory power of the predictive model (P < .001).

Conclusions: SCT variability is significantly greater than ACT variability and is strongly associated with the surgeon performing the procedure. Although these results suggest that SCT variability is an attractive operational target, further studies are needed to determine practitioner specific and modifiable attributes to reduce variability and improve efficiency.

Keywords: adult cardiac surgery database; anesthesia control time; coronary artery bypass grafting; operating room efficiency; surgeon control time; surgery variability.

Abstract

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