Increased Mean Time from End of Surgery to Operating Room Exit in a Historical Cohort of Cases with Prolonged Time to Extubation

Dexter, Franklin; Epstein, Richard H.

doi:10.1213/ane.0b013e3182a44d86

Cited by 62 publications

(82 citation statements)

References 35 publications

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“…6,8 Prolonged tracheal extubation times are particularly common ([ 20%) among long cases (e.g., four to six hours) performed in the prone position (e.g., spine surgery). 35 The mean times from end of surgery to OR exit are at least (95% lower confidence limit) 11.3 min longer when the tracheal extubation time is prolonged, whether stratified by duration of surgery and positioning (prone or not), procedure, or surgeon. 35 Our study was limited to the valuation of the time associated with prolonged tracheal extubation.…”

Section: Discussionmentioning

confidence: 95%

“…35 The mean times from end of surgery to OR exit are at least (95% lower confidence limit) 11.3 min longer when the tracheal extubation time is prolonged, whether stratified by duration of surgery and positioning (prone or not), procedure, or surgeon. 35 Our study was limited to the valuation of the time associated with prolonged tracheal extubation. Prolonged tracheal extubation times have other economic values depending on the perspective of the analysis (e.g., hospital vs physician).…”

Section: Discussionmentioning

confidence: 95%

“…The master surgical schedule influences which surgeons work on which days and thereby results in the presence of prolonged tracheal extubation times to be clustered by time of day and day of the week. 35 Consequently, the statistics were calculated using the method of batch means, [34][35][36][37] specifically, by pooling the proportions among four-week periods. For each of the two proportions (i.e., one per hypothesis), Visual Basic for Applications in Excel 2010 was used to perform the Freeman-Tukey transformation for every four-week period (Microsoft, Redmond, WA, USA).…”

Section: Methodsmentioning

confidence: 99%

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Cohort study of cases with prolonged tracheal extubation times to examine the relationship with duration of workday

Epstein

Dexter

Brull

2013

Can J Anesth/J Can Anesth

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Purpose The economics of the use of an anesthetic drug or device that produces benefit through reduction in operating room (OR) time depends on the day of the week and the total hours of surgical cases in the OR in which they are performed. Principally, this has to do with different durations of the regularly scheduled workday in the ORs within and among hospitals. We tested hypotheses relevant to the economic benefit of avoiding prolonged tracheal extubation times. Methods Observational data were obtained from a multiple-specialty academic tertiary hospital that uses an anesthesia information management system. Prolonged tracheal extubation times were considered those with tracheal extubations occurring 15 min or more after the end of surgery. The assessment of prolonged tracheal extubation times was limited to cases for which the patient's trachea was intubated and extubated while physically in the OR. Percentages were calculated for each of n = 39 four-week periods. Results are reported as mean (standard error of the mean) of these percentages, and the phrases ''at most/least'' are used to refer to the corresponding 95% confidence limits.Results At most, 6.1% [mean 5.5 (0.3)%] of the prolonged tracheal extubation times were attributable to cases that did not end during regular workdays from 7:00 AM-10:59 PM. At least 55.6% of prolonged tracheal extubation times occurred during cases on regular workdays and in an OR with more than eight hours of cases and turnovers [mean 57.0 (0.9)%; P \ 0.0001]. This percentage was 23.8 (0.8)% larger than for all other cases. Conclusions In the absence of an accurate facilityspecific cost analysis, prolonged tracheal extubation times should not be treated as fixed costs but as resulting in proportionally increased OR variable costs. RésuméObjectif En anesthésie, les économies résultant de l'utilisation d'un médicament ou d'un dispositif qui entraîne des avantages en réduisant le temps en salle d'opération (SO) dépendent du jour de la semaine et du nombre total d'heures de cas chirurgicaux réalisés dans cette salle. Ces économies ont surtout à voir avec les différences de durée d'une journée de travail normale planifiée dans les SO à l'intérieur de chaque hô pital et entre les hô pitaux. Nous avons testé des hypothèses pertinentes aux avantages économiques liés à la prévention d'un délai d'extubation trachéale prolongés. Méthode Nous avons obtenu des données observationnelles d'un hô pital tertiaire, universitaire et pluri-spécialisé qui se sert d'un système de gestion de l'information en anesthésie. Nous avons défini qu'il y avait

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 95%

Section: Methodsmentioning

confidence: 99%

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Cohort study of cases with prolonged tracheal extubation times to examine the relationship with duration of workday

Epstein

Dexter

Brull

2013

Can J Anesth/J Can Anesth

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“…4,17 An anesthesia technique with shorter extubation times would decrease waiting time for the operating room staff and reduce the time from the end of surgery to operating room exit. 5 Extubation times differ significantly among anesthetic drugs. 4,15,20 Propofol has become popular for general anesthesia, especially in the ambulatory setting.…”

Section: Discussionmentioning

confidence: 99%

Faster extubation time with more stable hemodynamics during extubation and shorter total surgical suite time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in lengthy lumbar spine surgery

Lin

Lee³

et al. 2016

SPI

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OBJECT Anesthesia techniques can contribute to the reduction of anesthesia-controlled time and may therefore improve operating room efficiency. However, little is known about the difference in anesthesia-controlled time between propofol-based total intravenous anesthesia (TIVA) and desflurane (DES) anesthesia techniques for prolonged lumbar spine surgery under general anesthesia. METHODS A retrospective analysis was conducted using hospital databases to compare the anesthesia-controlled time of lengthy (surgical time > 180 minutes) lumbar spine surgery in patients receiving either TIVA via target-controlled infusion (TCI) with propofol/fentanyl or DES/fentanyl-based anesthesia, between January 2009 and December 2011. A variety of time intervals (surgical time, anesthesia time, extubation time, time in the operating room, postanesthesia care unit [PACU] length of stay, and total surgical suite time) comprising perioperative hemodynamic variables were compared between the 2 anesthesia techniques. RESULTS Data from 581 patients were included in the analysis; 307 patients received TIVA and 274 received DES anesthesia. The extubation time was faster (12.4 ± 5.3 vs 7.0 ± 4.5 minutes, p < 0.001), and the time in operating room and total surgical suite time was shorter in the TIVA group than in the DES group (326.5 ± 57.2 vs 338.4 ± 69.4 minutes, p = 0.025; and 402.6 ± 60.2 vs 414.4 ± 71.7 minutes, p = 0.033, respectively). However, there was no statistically significant difference in PACU length of stay between the groups. Heart rate and mean arterial blood pressure were more stable during extubation in the TIVA group than in the DES group. CONCLUSIONS Utilization of TIVA reduced the mean time to extubation and total surgical suite time by 5.4 minutes and 11.8 minutes, respectively, and produced more stable hemodynamics during extubation compared with the use of DES anesthesia in lengthy lumbar spine surgery.

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“…3 Furthermore, prolonged (C 15 min) times for that period are associated with longer times to OR exit. [2][3][4][5][6] From Table 4 of reference 6 , among cases with prolonged times to tracheal extubation, the mean time from end of surgery to OR exit was 28 min. Therefore, among the authors' cases with tracheal intubation and extubation in the OR, what percentage of cases in the before and after periods had times C 28 min from the end of surgery to OR exit (i.e., as previously studied) or, alternatively, C 30 min (i.e., what an organization might monitor), and what was the corresponding relative risk and confidence interval?…”

Section: To the Editormentioning

confidence: 99%

Observational study of prolonged times to tracheal extubation

Dexter

Epstein

2015

Can J Anesth/J Can Anesth

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Increased Mean Time from End of Surgery to Operating Room Exit in a Historical Cohort of Cases with Prolonged Time to Extubation

Abstract: We recommend that anesthesia providers document the times of extubations and monitor the incidence of prolonged extubations as an economic measure. This would be especially important for providers at facilities with many ORs that have at least 8 hours of cases and turnovers.

Cited by 62 publications

References 35 publications

Cohort study of cases with prolonged tracheal extubation times to examine the relationship with duration of workday

Cohort study of cases with prolonged tracheal extubation times to examine the relationship with duration of workday

Faster extubation time with more stable hemodynamics during extubation and shorter total surgical suite time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in lengthy lumbar spine surgery

Observational study of prolonged times to tracheal extubation

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