THE EFFECT OF TRAINEE INVOLVEMENT ON PROCEDURE AND LIST TIMES IN ORTHOPAEDICS: AN INDEPTH STATISTICAL ANALYSIS FROM A TEACHING HOSPITAL IN UNITED KINGDOM

Abstract

Introduction: To train the surgeon adds to the length of procedures and this is currently not accounted for, in the finance received to perform the operation by the hospital.

Objective: Our study focussed on these main questions:

• What is the effect on the length of a procedure when a trainee is involved?

• What is the effect on the length of a list and the number of procedures performed on the list when a trainee is involved?

• What percentage of cases had trainee involvement for anaesthetics and surgery?

• Is this is statistically significant?

Method: Data was taken from two different sources, firstly, the ORMIS theatre system and patient operation notes. These were used to determine the length of six different types of orthopaedic procedures and the level of the main surgeon. This was collected in Stepping Hill hospital, Stockport, United Kingdom between June and July 2008. The second source used was a consultant’s logbook comprising 227 primary total knee replacements between 2004 and 2008.

Results: The data collected via the ORMIS system produced trends suggesting trainees took longer to perform procedures than consultants. The data from the consultant logbook statistically proved this. List times appeared unaffected by trainee presence. In Orthopaedic surgeries, 92% times trainees were present during the procedure and out of this 17% cases were performed by trainees. For total hip replacements done by trainees the procedure took significantly longer surgical time than consultant performed procedures (p = 0.0337).

Among these cases, 71% were performed by senior trainees. The consultant’s log book data also suggested the similar trends. In all comparisions, time taken by trainees to perform surgeries were statistically significant. Trainee performed with consultant scrubbed versus consultant performed (P = < 0.0001), trainee performed with consultant in theatre versus consultant performed(P = 0.0318) and trainee performed with consultant scrubbed versus trainee performed with consultant in theatre (P = 0.002)

Discussion and Conclusion: Hospitals are paid a fixed fees per operation due to introduction of payment by results system as they are paid a fixed tariff for a particular procedure. Training increases the length of a procedure and therefore in an efficient structured environment prevents as many cases being done on a list. Therefore, training future surgeons costs the hospital money. To counter this, training hospitals should be given financial incentives to train in surgery, or procedures performed by trainees should be priced differently to account for the time lost by training.