Pediatric Otolaryngology Procedure Duration and Impact of Resident Involvement Based on Training Level: 12,704 Cases

Introduction: To investigate the impact of resident physician performance on surgical time in pediatric otolaryngology by analyzing 12,704 cases.

Methods: A retrospective chart review was done on patients who had tonsillectomy and/or adenoidectomy, bilateral tympanostomy tube insertion (BMT), nasal cautery and closed nasal fracture repair from April 2016 to October 2023. Residents in their 2nd, 3rd, or 4th year and attending physicians were included. Patient demographics, American Society of Anesthesiology classification score, the time of day when the surgery was performed, and the surgeon level performing the procedure were analyzed as variables affecting the surgical time needed for procedure completion.

Results: Procedure time for adenoidectomy, adenotonsillectomy, and BMT was shortest when attending physicians performed the procedures, followed by PGY4s, PGY3s, and PGY2s respectively (p < 0.001). PGY4s had the shortest procedure time with nasal cautery, followed by attending physicians, PGY3s and PGY2s, respectively (p = 0.0086). As for tonsillectomy alone, attending physicians had the shortest procedure time, followed by PGY3s, PGY4s, and PGY2s, respectively (p < 0.001). Comparing trainees to attending physicians showed the following results: When the procedure was done by trainees, surgical time for BMT was 0.089 minutes longer with each additional year in patient age (p = 0.0042). For adenotonsillectomy performed by trainees, surgical time was 0.95 mins longer in the afternoon compared to the morning (p = 0.0178). By integrating the surgical cost to the additional time required by trainees for procedure completion, the estimated cost on all cases would be $802,254.

Conclusions: Surgical time to complete common pediatric otolaryngology procedures is shorter with advanced surgeon training level. Given the high volume of surgeries in pediatric otolaryngology, the additional time required by trainees to complete these procedures impacts cost, highlighting the need for academic attending physicians to weigh the balance between the financial considerations of healthcare delivery and the mission to educate future clinicians.