Operating room efficiency improvement after implementation of a postoperative team assessment

Porta, Christopher R.; Foster, Andrew; Causey, Marlin Wayne; Cordier, Patricia; Ozbirn, Roger; Bolt, Stephen; Allison, Dennis; Rush, Robert M.

doi:10.1016/j.jss.2012.12.004

Cited by 42 publications

(32 citation statements)

References 10 publications

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“…However, the effects of these variables, in addition to operative team proficiency, remain largely undescribed . Porta et al previously demonstrated that issues related to radiology, intraoperative supplies, surgeons, and nursing may contribute to the total time spent in the operating room. However, as others have previously demonstrated, coordinated efforts among operative team members can reduce the total time spent in the operating room .…”

Section: Discussionmentioning

confidence: 99%

“…Porta et al previously demonstrated that issues related to radiology, intraoperative supplies, surgeons, and nursing may contribute to the total time spent in the operating room. However, as others have previously demonstrated, coordinated efforts among operative team members can reduce the total time spent in the operating room . The association between preoperative WBC count and anastomotic leak, which parallels findings from the cardiovasculature literature, also serves as an area for future investigation.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure‐targeted analysis

Hall

Flores

Parshall

et al. 2019

Journal of Surgical Oncology

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Background: Anastomotic leak is the most common major complication after esophagectomy. We investigated the 2016 American College of Surgeons National Surgical Quality Improvement Program esophagectomy targeted database to identify risk factors for anastomotic leak.Methods: Patients who underwent esophagectomy for cancer were included. Patients experiencing an anstomotic leak were identified, and univariate and multivariable logistic regression was performed to identify variables independently associated with anastomotic leak.Results: Of 915 patients included, 83% were male and the median age was 64 years.Patients with anastomotic leak more frequently had additional complications (87% vs 36%, P < .001). Rates of reoperation (64% vs 11%, P < .001) and mortality (8% vs 2%, P = .001) were higher in patients with anastomotic leak. After adjusting for patient and procedure characteristics, prolonged operative time (for each additional 30-minutes; adjusted odds ratios (AOR) 1.068, 95% CI, 1.022-1.115, P = .003), increased preoperative WBC count (for each 3000/µL increase; AOR 1.323, 95% CI, 1.048-1.670, P = .019), pre-existing diabetes (AOR 1.601, 95% CI, 1.012-2.534, P = .045), and perioperative transfusion (AOR 1.777, 95% CI, 1.064-2.965, P = .028) were independently associated with anastomotic leak.Conclusion: Both patient and procedure-related factors are associated with anastomotic leak. Though frequently non-modifiable, these findings could facilitate risk stratification and early detection of anastomotic leak to reduce associated morbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure‐targeted analysis

Hall

Flores

Parshall

et al. 2019

Journal of Surgical Oncology

View full text Add to dashboard Cite

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“…As such, minimizing time spent within the OR plays a pivotal role in reducing costs and maximizing resource utilization. [22,23] It is currently estimated that running a single simple OR at a tertiary care facility costs an average of 36-37 USD per minute and can range anywhere from 22-133 USD per minute. [24,25] Reducing patient time to discharge, even if it is only by a few minutes, may result in decreased cost for the OR.…”

Section: Discussionmentioning

confidence: 99%

Sugammadex administration shortens reversal times but not operating room turnover times

Enten¹,

Albrink

Deng

et al. 2019

CSS

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Objective: Current literature debates whether administration of sugammadex translates into a higher operating room (OR) efficiency when compared to neostigmine. This study is a blinded assessment of the effects of sugammadex versus neostigmine on OR efficiency as determined by time of reversal to time of the next case.Methods: 50 patients undergoing abdominal surgery were randomized and evenly distributed into two groups, one receiving sugammadex (4 mg/kg) and the other, neostigmine (0.06 mg/kg) plus glycopyrrolate (0.004 mg/kg). Muscle paralysis was induced with intravenous rocuronium (0.6 mg/kg). Train of four (TOF) was monitored using acceleromyography every 10 minutes until reversal. Reversal agents were blindly prepared and administered during closing. TOF was then recorded every minute until a T4/T1 ratio ≥ 0.9 was achieved. This was designated as time of complete reversal. Subsequently, post-reversal outcome measures were collected.Results: Patients receiving sugammadex experienced a significantly shorter reversal time compared to those receiving neostigmine and glycopyrrolate (2.92 ± 1.71 minutes vs. 7.68 ± 5.63 minutes; p = .0002). No other outcome measures were significantly different between groups: time of OR ready for next case was 55.4 min vs. 56.1 min respectively; not significant.Conclusions: While sugammadex was significantly faster at reversing patient neuromuscular blockade the time from reversal to patient extubation after Sugammadex was prolonged. . This could be due to blinding, as blinded providers are unable to anticipate time of reversal and must compensate by making decisions at safe fixed intervals. This is reflected in that the time gained by administration of sugammadex is approximately equal to the delay experienced across all endpoints collected to the patients’ actual discharge.

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“…Specifically, we test whether and how hospitals differ in their OR efficiency before and after they enter a benchmarking program. In line with prior research and with the standard procedures issued by relevant stakeholders in the OR area, we define OR efficiency in terms of the following KPIs: raw utilization, turnover times, and first-case tardiness [3,6,[10][11][12][13][14][15][16]. If OR efficiency improved after entering the program, this could indicate that participating in a benchmarking and reporting program helps to raise awareness and develop effective strategies to realize efficiency gains.…”

Section: Introductionmentioning

confidence: 99%

Operating Room Efficiency before and after Entrance in a Benchmarking Program for Surgical Process Data

et al. 2017

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Operating room (OR) efficiency continues to be a high priority for hospitals. In this context the concept of benchmarking has gained increasing importance as a means to improve OR performance. The aim of this study was to investigate whether and how participation in a benchmarking and reporting program for surgical process data was associated with a change in OR efficiency, measured through raw utilization, turnover times, and first-case tardiness. The main analysis is based on panel data from 202 surgical departments in German hospitals, which were derived from the largest database for surgical process data in Germany. Panel regression modelling was applied. Results revealed no clear and univocal trend of participation in a benchmarking and reporting program for surgical process data. The largest trend was observed for first-case tardiness. In contrast to expectations, turnover times showed a generally increasing trend during participation. For raw utilization no clear and statistically significant trend could be evidenced. Subgroup analyses revealed differences in effects across different hospital types and department specialties. Participation in a benchmarking and reporting program and thus the availability of reliable, timely and detailed analysis tools to support the OR management seemed to be correlated especially with an increase in the timeliness of staff members regarding first-case starts. The increasing trend in turnover time revealed the absence of effective strategies to improve this aspect of OR efficiency in German hospitals and could have meaningful consequences for the medium- and long-run capacity planning in the OR.

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Operating room efficiency improvement after implementation of a postoperative team assessment

Cited by 42 publications

References 10 publications

Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure‐targeted analysis

Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure‐targeted analysis

Sugammadex administration shortens reversal times but not operating room turnover times

Operating Room Efficiency before and after Entrance in a Benchmarking Program for Surgical Process Data

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