Influence of the Surgeon's First Operation of the Day on Patient Outcomes.

Objective: To investigate whether the cumulative operative time spent by a surgeon operating on patients on the same day prior to starting a new procedure was associated with surgical outcomes.

Background: The impact of daily operating room workload on a surgeon's performance and patient outcomes is uncertain.

Methods: All elective patients, operated by attending surgeons across seven specialties in four French hospitals between 11/01/2020-12/31/2021, were included. Surgeons' operative workload the same day before each operation was measured in minutes by cumulating incision-to-closure times for all their patients as the primary operator. Composite of adverse events within 30 days post-surgery, encompassed major surgical complications, unplanned reoperation, extended ICU stay, and patient death. Generalized linear mixed models estimated the association between each outcome and operative workload, considering the clustering of operations by surgeons, and adjusting for patient comorbidities, procedure complexity, and surgeon characteristics.

Results: The cohort included 7,979 elective surgeries performed by 44 surgeons. Composite adverse events rates were higher in the 0-minute group compared to those with a higher duration (20.7% vs. 12.5%, P <0.001), as were rates of major complications (19.3% vs. 11.7%, P <0.001), reoperations (6.5% vs. 3.4%, P =0.005), and ICU stay (3.7% vs. 1.2%, P =0.016). When the surgeon had already spent time operating on patients prior to the procedure, adjusted relative risks were lower for composite adverse events (aRR 0.85 [95%CI 0.76-0.95]), major complications (0.86 [0.76-0.97]), reoperation (0.78 [0.63-0.97]), and ICU stay (0.69 [0.49-0.98]).

Conclusions: First patient of the day may experience worse outcomes, prompting surgeons to warm up before starting surgery. Further research is needed to replicate these findings, as many surgeons may prioritize starting with the most complex and challenging cases, which inherently carry greater risks.