How long do we need teaching in the operating room? The true costs of achieving surgical routine.

Background: Our aim was to quantify the incremental costs of longer operating times of residents and less-experienced junior consultants when compared with senior consultants on the basis of two surgical routine procedures.

Methods: We prospectively assessed 246 patients who underwent laparoscopic cholecystectomy and 216 patients who underwent open inguinal hernia repair. Operating times, complication rates and overall costs for these patients were recorded and linked to the attending surgeons.

Results: Most importantly, operating times significantly depend on the surgeon (P<0.001) and on proper supervision of junior surgeons (P<0.001 to P=0.003). When compared with those of senior surgeons, incremental costs for the hospital provider were Euro 200 and Euro 54 per laparoscopic cholecystectomy and Euro 153 and Euro 106 per open hernia repair when carried out by junior consultants and residents, respectively. Overall incremental costs per year for these procedures were Euro 8,370 for residents and Euro 22,922 for junior consultants.

Conclusion: Owing to longer operating times for junior consultants the costs of achieving surgical routine are considerably higher than previously estimated. These higher costs derive from junior consultants performing operations without proper supervision from senior consultants. We conclude that prolonged supervision in the operating room is highly cost-effective regardless of higher costs for personal resources per operating-minute.