PSU18 Exploring Cumulative SUM (CUSUM) As a Method to Evaluate Change in Operating Room Time in the Initial Cases of a Surgeon Using Robotic Assisted Surgery (RAS)

Abstract

Title: Exploring Cumulative Sum (CUSUM) as a Method to Evaluate Change in Operating Room Time in the Initial Cases of a Surgeon Using Robotic Assisted Surgery (RAS). Over the past 20 years, RAS has seen increased adoption globally as a minimally invasive surgical approach. Since RAS is newer than conventional laparoscopy, researchers have sought to evaluate the variation in OR time for a surgeon’s initial RAS cases. In this research, we explore CUSUM charts generated from daVinci Surgical System (dVSS) system log data (dVSSLD) as a potential method for evaluating the OR times in a surgeon’s initial cases of RAS. In the 1970s, CUSUM emerged as a tool for surgeons to visually characterize variation over time in surgical procedures. We extracted console time from dVSSLD for the first 50 procedures for all surgeons over the past 3 years (2018-2020) to generate the following CUSUM charts: (1) all specialties; (2) by specialty; and (3) by country for the US, China, Japan, and Germany. The overall CUSUM chart suggests that approximately 19 cases is the apex of a surgeon’s OR time. The CUSUM apex of OR time by specialty varied from 14-24 cases for cholecystectomy and partial nephrectomy, respectively. Surgeons performing malignant and benign hysterectomy reached an apex at 15 cases. CUSUM by country varied from 10 in China to 47 cases in Germany. The apex of the US, with the greatest amount of data, was at 26. The CUSUM appears to be a sufficiently sensitive methodology for evaluating variation in OR time for a surgeon’s initial RAS cases. The CUSUM varied noticeably in shape by specialty. Variation was also noticeable in the CUSUM by country suggesting that OR time may be influenced by practice specific to country.