Similarities Between Pediatric and General Hospitals Based on Fundamental Attributes of Surgery Including Cases Per Surgeon Per Workday.

Abstract

IntroductionOperating room (OR) management decision-making at both pediatric and adult hospitals is determined, in large part, by the same fundamental attributes of surgery and other considerations related to case duration prediction. These include the non-preemptive nature of surgeries, wide prediction limits for case duration, and constraints to moving or resequencing cases on the day of surgery. Another attribute fundamentally affecting OR management is the median number of cases a surgeon performs on their OR days. Most adult surgeons have short lists of cases (i.e., one or two cases per day). Similarly, at adult hospitals, growth in caseloads is mostly due to the subset of those surgeons who also operate just once or twice per week. It is unknown if these characteristics of surgery apply to pediatric surgeons and pediatric hospitals as well.MethodsOur retrospective cohort study included all elective surgical cases performed at the six pediatric hospitals in Florida during 2018 and 2019 (n = 71,340 cases). We calculated the percentages of combinations of surgeon, date, and hospital (lists) comprising one or two cases, or just one case, and determined if the values were statistically >50% (i.e., indicative of “most”). We determined if most of the growth in caseload and intraoperative work relative value units (wRVUs) at the pediatric hospitals between 2018 and 2019 accrued from low-caseload surgeons. Results are reported as mean ± standard error of the mean.ResultsAveraging among the six pediatric hospitals, the non-holiday weekday lists of most surgeons at each facility had just one or two elective cases, inpatient and/or ambulatory (68.1%; p = 0.016 vs. 50%, n = 27,557 lists). Growth in surgical caseloads from 2018 to 2019 was mostly attributable to surgeons who in 2018 averaged ≤2.0 cases per week (76.3% ± 5.4%, p = 0.0085 vs. 50%). Similarly, growth in wRVUs was mostly attributable to these low-caseload surgeons (73.8% ± 5.4%, p = 0.017 vs. 50%).ConclusionsLike adult hospitals, most pediatric surgeons’ lists of cases consist of only one or two cases per day, with many lists containing a single case. Similarly, growth at pediatric hospitals accrued from low-caseload surgeons who performed one or two cases per week in the preceding year. These findings indicate that hospitals desiring to increase their surgical caseload should ensure that low-caseload surgeons are provided access to the OR schedule. Additionally, since percent-adjusted utilization and raw utilization cannot be accurately measured for low-caseload surgeons, neither metric should be used to allocate OR time to individual surgeons. Since most adult and pediatric surgeons have low caseloads, this is a fundamental attribute of surgery.