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The cost of intraoperative plastic surgery education.

Abstract 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.
PMID
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Authors

Mayor MeshTerms

Internship and Residency

Medical Staff, Hospital

Operative Time

Keywords

Medical Knowledge

Patient Care

Practice-Based Learning and Improvement

cleft lip

cleft palate

craniofacial

operative time

opportunity cost

resident education

Journal Title journal of surgical education
Publication Year Start




PMID- 24016378
OWN - NLM
STAT- MEDLINE
DA  - 20130910
DCOM- 20140512
LR  - 20130910
IS  - 1878-7452 (Electronic)
IS  - 1878-7452 (Linking)
VI  - 70
IP  - 5
DP  - 2013 Sep-Oct
TI  - The cost of intraoperative plastic surgery education.
PG  - 655-9
LID - 10.1016/j.jsurg.2013.04.008 [doi]
LID - S1931-7204(13)00118-9 [pii]
AB  - PURPOSE: 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. METHODS: 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. RESULTS:
      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.
      CONCLUSIONS: 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.
CI  - Copyright (c) 2013 Association of Program Directors in Surgery. Published by
      Elsevier Inc. All rights reserved.
FAU - Sasor, Sarah E
AU  - Sasor SE
AD  - Division of Plastic Surgery, Riley Hospital for Children, Indiana University
      Medical Center, Indianapolis, Indiana. Electronic address: [email protected]
FAU - Flores, Roberto L
AU  - Flores RL
FAU - Wooden, William A
AU  - Wooden WA
FAU - Tholpady, Sunil
AU  - Tholpady S
LA  - eng
PT  - Journal Article
DEP - 20130524
PL  - United States
TA  - J Surg Educ
JT  - Journal of surgical education
JID - 101303204
SB  - IM
MH  - Adult
MH  - Cleft Lip/*surgery
MH  - Costs and Cost Analysis
MH  - Female
MH  - Humans
MH  - Indiana
MH  - *Internship and Residency
MH  - Intraoperative Period
MH  - Male
MH  - *Medical Staff, Hospital/economics/organization & administration
MH  - *Operative Time
MH  - Otolaryngology/economics
MH  - Physician's Role
MH  - Relative Value Scales
MH  - Surgery, Plastic/economics/*education
MH  - Teaching/*organization & administration
OTO - NOTNLM
OT  - Medical Knowledge
OT  - Patient Care
OT  - Practice-Based Learning and Improvement
OT  - cleft lip
OT  - cleft palate
OT  - craniofacial
OT  - operative time
OT  - opportunity cost
OT  - resident education
EDAT- 2013/09/11 06:00
MHDA- 2014/05/13 06:00
CRDT- 2013/09/11 06:00
PHST- 2013/02/06 [received]
PHST- 2013/03/20 [revised]
PHST- 2013/04/14 [accepted]
AID - S1931-7204(13)00118-9 [pii]
AID - 10.1016/j.jsurg.2013.04.008 [doi]
PST - ppublish
SO  - J Surg Educ. 2013 Sep-Oct;70(5):655-9. doi: 10.1016/j.jsurg.2013.04.008. Epub
      2013 May 24.