Case Difficulty, Postgraduate Year, and Resident Surgeon Stress: Effects on Operative Times

Area of Science:

• Surgical Education
• Minimally Invasive Surgery
• Operative Performance Metrics

Background:

• Evaluating surgical resident performance is crucial for effective training.
• Operative time is a key metric, but its relationship with trainee experience, case complexity, and stress is not fully understood.

Purpose of the Study:

• To assess how postgraduate year (PGY), surgical case difficulty, and resident stress influence operative times during laparoscopic cholecystectomy.

Main Methods:

• Prospective analysis of 268 laparoscopic cholecystectomies.
• Operative times were segmented, and resident stress was measured using electrodermal activity.
• Case difficulty was objectively assessed by trained observers.

Main Results:

• Operative time significantly increased with higher case difficulty (approx. 130% longer per difficulty increment).
• Postgraduate year (PGY) level showed minimal impact on operative times, except in the easiest cases.
• Resident stress demonstrated a weak correlation with operative times across all difficulty levels.

Conclusions:

• Increasing surgical case difficulty is the primary driver of longer operative times for residents.
• Postgraduate year (PGY) and resident stress have limited influence on operative duration in this procedure.