Operative time variability: Understanding and navigating a risk affecting surgeon and hospital efficiency

Background: There is limited prior literature on the relationship between operative time and its relative variability. We sought to identify the risk, in terms of operative time variability, that urologists as well as health systems assume with the scheduling of urologic surgical procedures. Methods: The 2015–2018 National Surgical Quality Improvement Program database was queried for single current procedural terminology (CPT) code urologic surgery cases. Cases missing a positive value for operative time or work relative value units were excluded. After exclusion of the 3.7% of the least performed cases by CPT code with greater than 100 cases performed, Spearman rank correlation coefficient was calculated to measure the association between mean operative time and coefficient of variation for the identified cases. Results: Of the 147,501 cases queried, the mean operative time was 98.3 min, mean standard deviation (SD) in operative time was 47.5 min, and the coefficient of variation was 0.48. Coefficient of variation was strongly negatively correlated with mean operative time (ρ = -0.801), indicating that shorter procedures tended to have relatively higher SDs in operative time for their mean operative time when compared to longer procedures. Conclusion: To the best of our knowledge, we are the first to report that the coefficient of variation is negatively correlated with mean operative time using a national dataset adding to the generalizability of prior literature utilizing single hospital datasets. Incorporation of these data in surgical scheduling may reduce various risks for both urologists as well as health systems.