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Microcomplications in laparoscopic cholecystectomy: impact on duration of surgery and costs

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Abstract

Background

In the era of cost-constrained health care, optimal resource utilisation becomes fundamental in daily clinical practice. Currently, processes during surgery are poorly defined and workflows need to be scrutinised. This investigation aimed at identifying interruptions of surgical workflow and quantifying their impact on the duration of surgery and costs.

Methods

Interruptions of surgical workflow were defined as microcomplications (MC) and divided into the following subgroups: communication-related (CR), instrument changes (IC), missing instruments (MI), instrument failure (IF), waiting for a senior surgeon (SS), anaesthesia-related (AR) and position changes (PC). Audio–video records of laparoscopic cholecystectomies were reviewed regarding type, frequency and duration of MC. Risk factors for MC were investigated in a multivariable linear regression analysis. The costs of MC due to intraoperative delay were calculated.

Results

Twenty audio–video records of laparoscopic cholecystectomies with a total duration of 28.9 h were reviewed. The median frequency of MC was 95 events/h with an overall duration of 452 min, corresponding to a delay of 15.6 min/h. Most frequent causes for MC were CR (32 events/h) and IC (54 events/h), leading to a total delay of 6.5 min/h for CR and 4.5 min/h for IC, respectively. MI and IF were less frequent (2.0 and 5.4 events/h), but single events lasted longer, resulting in a total delay of 1.4 min/h in MI and 2.1 min/h in IF. Intraoperative delays due to SS, AR or PC were rare. Multivariable regression analysis revealed previous abdominal surgery and cholecystitis as risk factors for a longer duration of MC (p = 0.004; p = 0.046). Based on OR minute costs of € 31.98, the delay due to MC led to additional costs of € 499/h.

Conclusions

MC cause relevant intraoperative delay and increased costs. Step-by-step protocols for a laparoscopic cholecystectomy may lead to a reduction in MC and should be further evaluated.

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Acknowledgments

The authors want to thank Charles Rudin for his great technical support and advice in audio–video recording and preparing the audio–video records for analysis and Thenral Socrates for her careful and critical review of the manuscript as a native speaker.

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Authors and Affiliations

  1. Department of Surgery, University Hospital Basel, Basel, Switzerland

    Marco von Strauss und Torney, Salome Dell-Kuster, Henry Hoffmann, Urs von Holzen, Daniel Oertli & Rachel Rosenthal

  2. Department of Surgery, Cantonal Hospital Aarau, 5001, Aarau, Switzerland

    Marco von Strauss und Torney

  3. Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland

    Salome Dell-Kuster

  4. Indiana University School of Medicine South Bend, Indiana University Health Goshen Center for Cancer Care, Goshen, IN, USA

    Urs von Holzen

Authors
  1. Marco von Strauss und Torney
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  2. Salome Dell-Kuster
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Correspondence to Marco von Strauss und Torney.

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Disclosures

Rachel Rosenthal is an employee of F. Hoffmann-La Roche Ltd. since 1 May 2014. The present study was conducted before Rachel Rosenthal joined F. Hoffmann-La Roche Ltd. and therefore has no connection to her current employment. Marco von Strauss und Torney, Salome Dell-Kuster, Henry Hoffmann, Urs von Holzen and Daniel Oertli have no conflicts of interest or financial ties to disclose.

Appendix

Appendix

See Table 6.

Table 6 Ideal cholecystectomy*
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von Strauss und Torney, M., Dell-Kuster, S., Hoffmann, H. et al. Microcomplications in laparoscopic cholecystectomy: impact on duration of surgery and costs. Surg Endosc 30, 2512–2522 (2016). https://doi.org/10.1007/s00464-015-4512-3

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  • DOI: https://doi.org/10.1007/s00464-015-4512-3

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