Duration of surgical procedures

Duration of surgical proceduresThe duration of a certain surgical procedure is often mentioned in the literature to document the complexity or simplicity of an operation, or the skill of the surgeons.

It is obvious that major procedures take more time while minor surgery should be shorter but what is long or short? Is it defined?

It is also well known that besides the skill of the surgeon and his experience with a specific operation other factors play a role in determining its duration. Is it an emergency procedure or an elective one? Does the surgeon operate by himself or guides n resident? Is he assisted by competent surgical assistants or by other health professional?

We assume, however, that major elective procedures published in the literature are performed in leading centers under optimal conditions. Why then is the reported duration of operation so variable. For example the mean duration of the Whipple procedure varies between 4 to 8 hours in the different series; palliative bypass for obstructive jaundice is performed by some in 2 hours while others take a mean of 6 hours…Why is it so?

There must be some “cultural” reasons which provide the impetus for surgeons in one country to be “fast” and surgeons in another country to be “slow”. One such possible reason is the OR and Department of Anesthesia. In some countries the anesthetists are “interested” in “shorter” procedures: “to take the patient off the bed and go and have tea” . In other places the OR and anesthetists bill per hour or minute… ; “as long as the OR is busy the dollar clock ticks; so why hurry-let the surgeon operate and operate…”.

We know that too hasty operations are potentially hazardous, and that one can not adequately think or teach under excessive pressure to “finish”. On the other hand we know that excessive length has potential complications such as: hypothermia, DVT, atelectasis, wound infections, surgeon’s exhaustion and financial morbidity. So where is the balance? What is the optimal duration?

Hypothesis: there are drastic diferences in the mean duration of similar procedures published in the literature. The duration of operations differ in various countries reflecting tradition,culture, and (negative) financial pressures.

What do you think about this issue? Many of you worked in different countries or places and may have some thoughts to shade new light!

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