Published Operative Times Do Not Reflect Surgeon Effort: A Novel Approach for Calculating Operative Times in Total Hip Arthroplasty to Better Quantify Surgeon Work

Background: Current estimates of operative time (OT) for total hip arthroplasty (THA) are reported as the mean OT across all procedures. This method does not reflect variability among surgeons and surgical settings and should not be used to infer individual surgeon work. We hypothesized that this method would underestimate the time it takes individual surgeons to perform THA. Therefore, we compared the mean OT for all THA cases ("overall OT") with the mean OT for individual surgeons ("individual surgeon OT") and examined which factors were associated with each.

Methods: Mean OT was calculated for 3972 primary THA cases ("overall OT") by 41 surgeons from 2015 to 2018 in a single health system. The mean OT for each surgeon was determined ("individual surgeon OT"), averaged across surgeons, and compared with overall OT. Overall OT and individual surgeon OT were assessed for associations with surgeon-related (adult reconstruction fellowship training, THA volume, years' experience), hospital-related (hospital type, trainee presence), and patient-related (age, body mass index category, American Society of Anesthesiologists physical status classification) factors (alpha = 0.05).

Results: Mean individual surgeon OT was significantly longer (106 ± 21 minutes) than overall OT (96 ± 28 minutes) (P = .03), with 73% of individual surgeon OTs being greater than overall OT. Although all surgeon-, hospital-, and patient-related factors were associated with significant differences in overall OT, only hospital type was associated with differences in individual surgeon OT.

Conclusion: Individual surgeon OT was longer than overall OT for most surgeons and provides a better estimate of surgeon work.