Orthopaedic "Time"

Anaesthetist: “How long will this surgery take?”

Orthopaedic surgeon: *confused* “45 mins” . "Why do you ask?"

Anaesthetist: To plan the list and let the next patient have the pre-meds at the right time! *With a little smile on his face (almost a snigger)* with cheeky eye contact with ODP and theatre scrub team!

A common scenario in most Orthopaedic theatres. The anaesthetists always assuming that the orthopaedic surgeons are underestimating the time taken to perform surgery and the orthopaedic surgeons blaming the anaesthetists for MAFAT (Mandatory anaesthetic faff around time)

So, is this true?

Is time really fluid? Is it different in an orthopaedic theatre? Is the orthopaedic theatre in a parallel universe to earth? Do the anaesthetist and the orthopaedic surgeons wear different brands of watches?

?Or do orthopaedic surgeons really underestimate their surgical times?

The pressure to put more on the list to get through waiting lists will make any surgeon underestimate surgical times. Is this the right thing to do, perhaps not. ?

Many a times, an orthopaedic surgeon unknowingly underestimates the surgical time. Despite meticulous pre-operative planning, things don’t always go as per plan. This may be unusual for the individual surgeon, but the anaesthetist who works with several surgeons every day of the week may be experiencing this more often – which would prime their brain like a Pavlovian reflex to assume the surgeon is always underestimating their surgical times.

The orthopaedic surgeon who performs the same procedure over and over again like a primary total knee replacement [TKR](“factory production line”) will be more accurate in predicting their surgical time, but then will be thrown off course if he has a complex primary TKR or a navigated TKR, underestimating the time.

Believe it or not, there is a study published in BMJ in 2014 looking at this exact issue and the results are quite contradictory and controversial. 92 participants (Orthopaedic, Plastics, General surgery and Anaesthetic consultants & registrars) were asked to estimate their surgical times, and this was compared with actual time stamps recorded for each procedure.?The orthopaedic surgeons and plastic surgeons were found to be the most accurate in predicting their surgical times (overestimating by 1 min and underestimating by 5 mins respectively). The Anaesthetists and general surgeons were way off the mark, underestimating their times by 35 and 31 mins respectively, meaning that their procedures took on average 167% and 28% longer than estimated, For vanity purposes, I am not going to mention here the inherent biases in the study which was conducted by the orthopaedic surgeons. ?

The theatre “time” is precious and expensive. Various processes / initiatives have been developed to make theatre utilisation efficient such as “Productive operating theatre in UK NHS”. Modern operating theatres should have no place for stereotyping orthopaedic surgeons or anaesthetists.