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Not an Assembly Line

Panchbhavi, Vinod K. MD, FACS, FAOA, FABOS, FAAOS

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Techniques in Foot & Ankle Surgery: September 2020 - Volume 19 - Issue 3 - p 123
doi: 10.1097/BTF.0000000000000287
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As surgeons, we often have several patients scheduled for a variety of surgical interventions or operations on the days we operate. A lot of planning goes on behind the scenes to make operating days go smoothly and for the surgical procedures to be done in a timely fashion. For day-surgery patients, each patient on the schedule is given a specific time to arrive at the facility. The hope is that all patients scheduled for that day get the surgery done with a minimal amount of waiting time. The arrival times for the patients that follow the first patient are based on predictions of time each of the cases posted for that day might take. One important criterion taken into consideration is the estimated time expected to be taken for each case by the surgeon from “cut-to-close.” These estimated times are often based on the surgeon’s average historic times recorded for the type of procedure(s). However, the procedures identified by Current Procedural Terminology (CPT) codes can differ vastly in complexity. For example, a procedure such as deep hardware removal can be simple and easy in one patient, taking just a few minutes to complete, but in another patient, be a more complex and difficult task that takes over an hour.

It is beneficial from an administrative point of view and for patient satisfaction in general to avoid delays and reduce wait times for patients. Overestimation of time for a surgical procedure can help cushion any unexpected delays, but can lead to inefficient use of time. Underestimation, on the other hand, can lead to increased wait times, especially for patients scheduled towards the end of the day. These patients may get increasingly frustrated by the delay unless they are educated on the complexities and wide variation of cases and on challenges that exist in predicting the exact time needed for the surgical procedures that precede their procedure. The frustration can be minimized if patients and their families are prepared for possible delays and a longer than expected wait time on the day of surgery. They should understand that the arrival time given to them is the earliest possible time that they can expect their procedure to be undertaken. They need to be aware that if they are following other patients, they are in a queue and will proceed to surgery only after the procedures scheduled ahead of them are completed. It is also helpful to explain to patients that the surgical procedures scheduled for the day can take a variable amount of time because cases can vary in complexity.

In foot and ankle surgery, there is a lot of variation in complexity in the conditions we see. Therefore, the procedures to address these, although having similar CPT code, can vary greatly when it comes to the duration of time and effort that is required. It is not like cutting out cookies or decorating cupcakes with the same design, where each task takes the same amount of time and the time taken for each task is predictable. This is because not all bunion deformities are the same. As you can see in this issue, there are various surgical techniques brought to us by renowned authors and researchers. We are grateful to Dr Pal Ramesh Surgical interventions are far from predictable even for a seemingly similar problem. For example operations for bunion surgery. The time taken can vary from one patient to another. This is because not all the other authors who have provided great detail and insight into a variety of surgical techniques that can be used at times for similar problems. Each one of these techniques, even for similar problems, will take a variable amount of time in different patients. Therefore, predicting time for surgical procedures, despite having the same CPT code and same surgical technique, is difficult because each problem and each patient is unique. Each surgical operation is a work of art, not a task on an assembly line.

Vinod K. Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS

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