Who’s Better at Telling Operating Time?

Orthopedic surgeons are best, and anesthetists worst, at predicting operating theater time, according to orthopedic surgeons from New Zealand.

“Our hypothesis going in was that the anesthetic time would be longer than they expected, as surgeons have become very good at predicting the time they require in recent times, potentially as a results of the WHO safety checks and being asked by various theatre staff how long they will take and when to send for the next patient,” Dr. Elizabeth Travis from Waikato Hospital, Hamilton, New Zealand said.

Waiting times in the operating room have been a bone of contention between surgeons and anesthetists for years, with each side blaming the other for delays. Inaccurate predictions of the time required for surgery “are often wildly inaccurate, resulting in other team members idling extra time away refining their Sudoku skills and increasing their consumption of caffeine, tea, and biscuits,” the researchers say.

In an effort to put the issue to sleep, Dr. Travis’s team asked plastic, orthopedic, and general surgeons and anesthetists how long they thought their procedure would take. They compared these predictions with actual time data recorded at the end of the case.

It came as no surprise to the team of orthopedic surgeons that anesthetists fared worst, missing the actual time by an average of 35 minutes (a 167.5% underestimate). Orthopedic surgeons, naturally, fared best, missing by only 1 minute (a 1.1% overestimate).

General surgeons (31 minutes, a 28.7% underestimate) and plastic surgeons (5 minutes, a 4.5% underestimate) fell in between, according to the December 15th BMJ online report.

“This work follows on from seminal papers proving that orthopedic surgeons are stronger and more intelligent than anesthetists and shows they are also better at telling the time,” the researchers conclude.

“I think more research is needed to confirm the findings as they are not particularly generalizable at the moment,” Dr. Travis said. “But potentially theatre staff could make use of extra time if each specialty is asked to predict their required time and maybe accuracy would improve if people are regularly required to think about how long things take them.”
Then she revealed her ulterior motive: “The main message was for people to enjoy reading the article and bring a smile to people’s faces in the lead up to Christmas – a busy and stressful time in many hospitals!”

Dr. Franklin Dexter from University of Iowa in Iowa City has spent more than a decade studying operating times and their impact on hospitals and patients. He told Reuters Health, “Updating the estimate of the theatre time during the time out (i.e., before surgery begins) can be useful for add-on case scheduling (i.e., a subsequent case in that theatre). Every hospital has additional cases, because patients are admitted before surgery and get sicker.”

“Theatre management is science,” Dr. Dexter said. “Knowledge comes from experiments and analytics (mathematics). One cannot make evidence-based management decisions without relying on the science. This depends on learning the vocabulary.”