Operative Time Heterogeneity in Laparoscopic Cholecystectomy at High Altitude: Surgeon Variability as a Modifiable Factor under Hypoxic Stress
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Objective
To quantify inter-surgeon heterogeneity in operative efficiency of laparoscopic cholecystectomy (LC) at high altitude and identify independent determinants of operative time.
Methods
A single-center retrospective cohort study at the participating hospital (2,260 m altitude) included 591 elective LC cases by 7 surgeons (2020–2023). One-way ANOVA, multivariate regression with log-transformed operative time, nested model comparison, and ICC quantified surgeon versus baseline factor contributions.
This study followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting guidelines [16]; the checklist is provided in the supplementary materials.
Results
Inter-surgeon operative time differed significantly (F = 7.16, P < 0.001, η 2 = 0.069), with 12.64 min (24.0%) gap between fastest and slowest surgeons. Regression (Adj R 2 = 0.075, P < 0.001) identified age (β = 0.0029/yr, P = 0.009), male sex (β = 0.063, P = 0.019), and surgeon identity (Surgeon G β = 0.244, P < 0.001; Surgeon F β = 0.233, P = 0.001; Surgeon E β = 0.214, P = 0.018) as independent predictors. BMI showed a trend (P = 0.069). Nested comparison showed surgeon factors explained 2.02-fold more variance than all baseline factors combined (ΔR 2 = 0.063 vs R 2 = 0.031; ICC = 0.074). The F-statistic exceeded the F ≈ 2–4 range reported in plain-cohort LC studies.
Conclusion
Surgeon variability is the dominant modifiable determinant of operative time heterogeneity in high-altitude LC, contributing 2.02-fold more variance than patient baseline factors. Standardization of surgical technique represents a potentially important intervention target for efficiency improvement.
