Do anesthesia emergence times reflect resident training progression, educational competency, and operating room efficiency?

Abstract Background: Anesthesia residents are often subjectively and objectively deemed competent by their impact of cost-efficacy and perioperative metrics. Assessing knowledge acquisition and procedural skill is difficult to measure equitably. Inspecting tangible metrics of perioperative efficiency may or may not provide a source for reliable evaluation. Methods: Retrospective case-log database review yielded 3072 surgical cases involving residents over five years. Primary variable investigated was the time from surgery completion to exit from operating room. Other variables recorded included day of week, attending anesthesiologist name, attending surgeon name, patient age, sex, American Society of Anesthesiologists physical status classification (ASA PS), and in-patient versus day surgery status. Results: After controlling for procedure duration time, in-patient status, ASA class, surgeon, and attending anesthesiologist, resident training time became highly significant (p < 0.001). In the fully adjusted model, one year of resident training was associated with a reduction in emergence time by 28 seconds (95% CL = (12, 44)). A one-hour increase in procedure time was associated with an increase in emergence time of 34 seconds (95% CL = (17, 50)). Conclusions: Although a statistically significant correlation was demonstrated, the clinical significance is likely low given the relatively small amount of actual time saved. We question the value of utilizing perceived or measured perioperative metrics for evaluating anesthesia resident competency.