03/31/2016 10:03 EDT | Updated 04/01/2017 01:12 EDT

Surgeries at teaching hospitals take 22% longer, Canadian study finds

Common surgeries at Canadian teaching hospitals do take longer than at community hospitals but a new study suggests this may be costly and inefficient.

Training new surgeons is an essential part of healthcare, but time is money especially in the operating room, said Dr. Christopher Vinden, a general surgeon at London Health Sciences Centre.

When Vinden and his co-authors examined records for adults across Ontario who had 14 common surgical procedures from 2002 to 2012, they found overall it took 22 per cent longer on average at teaching hospitals or about 25 minutes more, compared with non-teaching hospitals.

"The magnitude of this increase is large enough to potentially affect direct and indirect costs, institution and surgeon efficiency, and possibly impact surgical outcomes," they concluded in this week's issue of the Canadian Journal of Surgery.

For example, Vinden says  longer surgical times are associated with adverse outcomes, such as higher infection rates and deep vein thrombosis or blood clots that can break off and lead to lung complications. Teaching hospitals also have advantages that likely cancel out those incrementally higher risks, he said.

Two subtle outliers in the findings also point to a potential new avenue to organize and schedule procedures, the study's authors said. 

Elective hip and knee replacements took only 7 to 9 per cent longer at teaching hospitals. The researchers speculate that the dedicated arthroplasty teams who work in specialized rooms could help explain the difference.

 "The two most common procedures that general surgeons do are hernias and then gall bladders," Vinden said in an interview. "We could certainly maybe have days when we do all the hernias in a row and then another day where we do a whole bunch of elective gall bladders in a row and I suspect that we'd see efficiencies."

For policy makers, Vinden said the findings point to how teaching institutions need to be compensated more per case than an equivalent case in a community hospital or else teaching centres will try to limit participation of trainees.