Pediatric Otolaryngology Procedure Duration by Training Level: 12,704 Case Analysis

To investigate the impact of resident involvement on pediatric otolaryngology procedure duration and study its financial implications on healthcare delivery.

A retrospective chart review of all patients who underwent tonsillectomy, adenoidectomy, tonsillectomy and adenoidectomy, nasal cautery, closed nasal reduction, and bilateral myringotomy tube insertion from April 2016 to October 2023 at a tertiary care center. Procedure duration, patient demographics, American Society of Anesthesiology class, body mass index percentile, case schedule time, and surgeon type were collected. The financial investment in trainees was calculated based on the difference in procedure duration between attending physicians and trainees, and the institution's preset value for otolaryngology case revenue.

Surgical time was greater for trainees compared to attending physicians in all procedures except for closed nasal reduction. When comparing trainees to attending physicians, surgical time was proportionally prolonged with increase in patient age in bilateral myringotomy tube insertion. Regarding tonsillectomy and adenoidectomy, American Society of Anesthesiology Class I, body mass index greater than 95th percentile and afternoon scheduling were associated with prolonged surgical time. Female sex was associated with increased surgical time when comparing trainees to attending physicians in patients who underwent an adenoidectomy alone. The financial investment was greatest for second year residents, recorded as $616.988 over the study period.

Surgical time decreases with surgeon experience for most pediatric otolaryngology procedures. Sex, body mass index, American Society of Anesthesiology class, case schedule time, and age are variables that impact surgical time. Resident training comes with a significant, yet necessary, cost spread over several years.