Effect of surgeon experience on technical efficiency

Productivity Change of Surgeons During the Coronavirus Disease 2019 Pandemic in Japan

The purpose of this study is to compute surgical total factor productivity before and during the pandemic with Malmquist index, and to evaluate the effect of coronavirus disease 2019 (COVID-19) on its productivity change. The COVID-19 pandemic has significantly shifted healthcare resources allocation; more healthcare resources have focused on measures against the COVID-19 pandemic. The authors collected data from all the surgical procedures performed in Teikyo University Hospital from April 1 through September 30 in 2019 and in 2020. Non-radial and non-oriented Malmquist model under the constant return-to-scale assumptions was employed. The decision-making unit was defined as a surgeon with the highest academic rank in surgery. Inputs were defined as (1) the number of medical doctors who assisted surgery and (2) the duration of surgical operation from skin incision to closure. The output was defined as the surgical fee for each surgery. The study period was divided into four 3-month periods. We added all the inputs and outputs of the surgical procedures for each decision-making unit during these study periods, and computed his/her Malmquist index, efficiency change, and technical change. Four thousand six hundred and two surgical procedures performed by 75 surgeons were analyzed. The productivity progressed significantly during 2019 (P = .008) while the productivity changes in 2020 were not significantly different from 0. On year-on-year comparisons, the productivity change was not significantly different from 0. The COVID-19 pandemic had a negative impact on the productivity progress of surgery that was unrelated to its countermeasures.