• Filippo Dagnino, Tephanie Polazzi, Jean-Christophe Lifante, Tanujit Dey, Antoine Duclos, and TopSurgeons Study Group.
• Department of Urology, Humanitas Clinical and Research Hospital, Milan, Italy.
• Ann. Surg. 2025 Feb 13.

ObjectiveTo investigate whether the cumulative operative time spent by a surgeon operating on patients on the same day prior to starting a new procedure was associated with surgical outcomes.BackgroundThe impact of daily operating room workload on a surgeon's performance and patient outcomes is uncertain.MethodsAll elective patients, operated by attending surgeons across seven specialties in four French hospitals between 11/01/2020-12/31/2021, were included. Surgeons' operative workload the same day before each operation was measured in minutes by cumulating incision-to-closure times for all their patients as the primary operator. Composite of adverse events within 30 days post-surgery, encompassed major surgical complications, unplanned reoperation, extended ICU stay, and patient death. Generalized linear mixed models estimated the association between each outcome and operative workload, considering the clustering of operations by surgeons, and adjusting for patient comorbidities, procedure complexity, and surgeon characteristics.ResultsThe cohort included 7,979 elective surgeries performed by 44 surgeons. Composite adverse events rates were higher in the 0-minute group compared to those with a higher duration (20.7% vs. 12.5%, P <0.001), as were rates of major complications (19.3% vs. 11.7%, P <0.001), reoperations (6.5% vs. 3.4%, P =0.005), and ICU stay (3.7% vs. 1.2%, P =0.016). When the surgeon had already spent time operating on patients prior to the procedure, adjusted relative risks were lower for composite adverse events (aRR 0.85 [95%CI 0.76-0.95]), major complications (0.86 [0.76-0.97]), reoperation (0.78 [0.63-0.97]), and ICU stay (0.69 [0.49-0.98]).ConclusionsFirst patient of the day may experience worse outcomes, prompting surgeons to warm up before starting surgery. Further research is needed to replicate these findings, as many surgeons may prioritize starting with the most complex and challenging cases, which inherently carry greater risks.Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc.

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