Statistical Modeling of Average and Variability of Time to Extubation for Meta-Analysis Comparing Desflurane to Sevoflurane

Dexter, Franklin; Bayman, Emine O.; Epstein, Richard H.

doi:10.1213/ane.0b013e3181b5dcb7

Cited by 123 publications

(164 citation statements)

References 48 publications

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“…This column is used in the last sentence of the Results identification. [2][3][4]8,19 The cost of performing a full analysis should be balanced against the potential cost of making an incorrect decision without such an analysis. In the absence of a full analysis for the economics of prolonged tracheal extubation times, our results show that hospitals in which most ORs schedule more than eight hours of cases and turnovers should treat OR time as a variable cost, not a fixed cost (see Introduction).…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] Approximately 15% of tracheal,extubations take 15 min or longer. 6,8 We tested whether a hospital choosing not to perform a full economic analysis, 2,3 should treat the cost of prolonged tracheal extubations as fixed or variable.…”

Section: Résumémentioning

confidence: 99%

“…8 This has to do with different durations of the regularly scheduled workday in the ORs within and among hospitals. The total hours of cases and turnovers in each OR differ more than twofold, not only among hospitals within the same country but also among ORs within hospitals.…”

Section: Résumémentioning

confidence: 99%

“…[16][17][18] The full cost analysis can be performed using data from randomized trials and the hospital's OR information system. 3,4,8,[19][20][21] Suppose that essentially all (e.g., [ 90%) ORs at a hospital have more than 8 hours of cases each workday. Then, OR time is a variable cost.…”

Section: Résumémentioning

confidence: 99%

“…23,24 It follows that OR time can reasonably be treated as a fixed cost. [1][2][3][4][5][6][7][8] In addition, completing more cases should be unexpected because small (e.g., five minutes) reductions in time are insufficient for reliably scheduling additional cases. 25,26 Overall revenue far exceeds variable costs because of the large fixed costs of surgical care, [27][28][29] and not performing a scheduled case increases net societal costs.…”

Section: Résumémentioning

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: 99%

Section: Résumémentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

Section: Résumémentioning

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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Principles of an Ambulatory Surgery Service

Salmon¹,

Patel²

2021

Ambulatory Urology and Urogynaecology

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Scientific fraud in 20 falsified anesthesia papers

Hein¹,

Zobrist

Konrad

et al. 2012

Anaesthesist

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Data from natural sources show counter-intuitive distribution patterns for the leading digits to the left of the decimal point and the digit 1 is observed more frequently than all other numbers. This pattern, which was first described by Newcomb and later confirmed by Benford, is used in financial and tax auditing to detect fraud. Deviations from the pattern indicate possible falsifications. Anesthesiology journals are affected not only by ghostwriting and plagiarism but also by counterfeiting. In the present study 20 publications in anesthesiology known to be falsified by an author were investigated for irregularities with respect to Benford's law using the χ(2)-test and the Z-test. In the 20 retracted publications an average first-digit frequency of 243.1 (standard deviation SD ± 118.2, range: 30-592) and an average second-digit frequency of 132.3 (SD ± 72.2, range: 15-383) were found. The observed distribution of the first and second digits to the left of the decimal point differed significantly (p< 0.01) from the expected distribution described by Benford. Only the observed absolute frequencies for digits 3, 4 and 5 did not differ significantly from the expected values. In an analysis of each paper 17 out of 20 studies differed significantly from the expected value for the first digit and 18 out of 20 studies varied significantly from the expected value of the second digit. Only one paper did not vary significantly from expected values for the digits to the left of the decimal. For comparison, a meta-analysis using complex mathematical procedures was chosen as a control. The analysis showed a first-digit distribution consistent with the Benford distribution. Thus, the method used in the present study seems to be sensitive for detecting fraud. Additional statements of specificity cannot yet be made as this requires further analysis of data that is definitely not falsified. Future studies exploring conformity might help prevent falsified studies from being published.

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Statistical Modeling of Average and Variability of Time to Extubation for Meta-Analysis Comparing Desflurane to Sevoflurane

Cited by 123 publications

References 48 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

Principles of an Ambulatory Surgery Service

Scientific fraud in 20 falsified anesthesia papers

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