NEW CONCEPT Bariatric Surgery Operating Room Time—Size Matters Joseph A. Sanford 1 & Bassam Kadry 1 & Jay B. Brodsky 1 & Alex Macario 1 # Springer Science+Business Media New York 2015 Abstract Background The goal of this study was to document the rela- tionship between BMI and the components of bariatric surgi- cal operating room (OR) time. Methods The Stanford Translational Research Integrated Da- tabase Environment identified all patients who underwent lap- aroscopic Roux-en-Y gastric bypass procedures at Stanford University Medical Center between May 2008 and November 2013. The 434 patients were divided into 3 groups: group 1 (n =213) BMI ≥35 to <45 kg/m 2 , group 2 (n =188) BMI ≥45.0 to <60 kg/m 2 , and group 3 (n =33) BMI ≥60 kg/m 2 . The pri- mary variable measured was total operating room time, defined as beginning when the patient entered the OR until the moment the patient physically left the OR. Secondary variables were anesthetic induction time, nursing preparation time, operation time, time for emergence from anesthesia, and total length of hospital stay. Results Increasing BMI was associated with increased total OR time (group 1=202 min, group 2=215 min, group 3= 235 min), mainly due to longer operation time (group 1= 147 min, group 2=154 min, group 3=163 min). Anesthetic induction (group 1=17 min, group 2=18 min, group 3= 23 min) and emergence times (group 1=12 min, group 2= 12 min, group 3=22 min) were also significantly longer in the largest patients. Conclusions Operating room schedules and plans for re- source utilization should recognize that the same bariatric pro- cedure will require more time for patients with BMI >60 kg/ m 2 than for smaller bariatric patients. Keywords Body mass index . Obesity . Super-super obesity . Healthcare . Cost Introduction Previous studies, most involving orthopedic surgery, have re- ported that total operating room (OR) time, that is, the amount of time required to complete a procedure measured from pa- tient entrance to exit from the operating room, increases with increasing patient body mass index (BMI, kg/m 2 )[1, 2]. Lon- ger operating room time can directly affect resource consump- tion and may contribute to significant inaccuracies in the sur- gical schedule. The goal of this study was to document the relationship between BMI and the individual components of bariatric surgical OR time. Joseph A. Sanford is a Fellow of the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, and holds a MD degree. Bassam Kadry is a Professor at the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, and holds a MD degree. Jay B. Brodsky is a Professor at the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, and holds a MD degree. Alex Macario is a Professor at the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, and holds a MD and MBA degree. * Jay B. Brodsky jbrodsky@stanford.edu Joseph A. Sanford jasanford@gmail.com Bassam Kadry bkadry@stanford.edu Alex Macario amaca@stanford.edu 1 Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA OBES SURG DOI 10.1007/s11695-015-1651-5