Economic impact of prolonged tracheal extubation times on operating room time overall and for subgroups of surgeons: a historical cohort study

Franklin Dexter; Anil A Marian; Richard H Epstein

doi:10.1186/s12871-024-02862-6

Prolonged tracheal extubation time is defined as an interval ≥ 15 min from the end of surgery to extubation. An earlier study showed that prolonged extubations had a mean 12.4 min longer time from the end of surgery to operating room (OR) exit. Prolonged extubations usually (57%) were observed during OR days with > 8 h of cases and turnovers, such that longer OR times from prolonged extubation can be treated as a variable cost (i.e., each added minute incurs an expense). The current study addressed limitations of the generalizability of these earlier investigations.BACKGROUNDProlonged tracheal extubation time is defined as an interval ≥ 15 min from the end of surgery to extubation. An earlier study showed that prolonged extubations had a mean 12.4 min longer time from the end of surgery to operating room (OR) exit. Prolonged extubations usually (57%) were observed during OR days with > 8 h of cases and turnovers, such that longer OR times from prolonged extubation can be treated as a variable cost (i.e., each added minute incurs an expense). The current study addressed limitations of the generalizability of these earlier investigations.The retrospective cohort study included cases performed at a university hospital October 2011 through June 2023 with general anesthesia, tracheal intubation and extubation in the OR where the anesthetic was performed, and non-prone positioning. The primary endpoint was the interval from end of surgery to OR exit. Mean OR time differences with/without prolonged extubation were analyzed pairwise by surgeon. The variance among surgeons was estimated using the DerSimonian-Laird method with Knapp-Hartung adjustment for the sample sizes of surgeons. Proportions were analyzed after arcsine transformation, and the inverse taken to report results.METHODSThe retrospective cohort study included cases performed at a university hospital October 2011 through June 2023 with general anesthesia, tracheal intubation and extubation in the OR where the anesthetic was performed, and non-prone positioning. The primary endpoint was the interval from end of surgery to OR exit. Mean OR time differences with/without prolonged extubation were analyzed pairwise by surgeon. The variance among surgeons was estimated using the DerSimonian-Laird method with Knapp-Hartung adjustment for the sample sizes of surgeons. Proportions were analyzed after arcsine transformation, and the inverse taken to report results.There were prolonged extubations for 23% (41,768/182,374) of cases. Prolonged extubations had a mean 13.3 min longer time from the end of surgery to OR exit (95% confidence interval 12.8-13.7 min, P < 0.0001). That result was among the 71 surgeons each with ≥ 9 cases having prolonged extubation times and ≥ 9 cases with typical extubation times. Results were similar using a threshold of ≥ 3 cases, comprising 257 surgeons (13.2 min, P < 0.0001). Among the 71 surgeons with at least nine prolonged extubations, on most days with a prolonged extubation during at least one of their cases, there were > 8 h of cases and turnover times in the OR (77%, 73%-81%, P < 0.0001). Results were similar when analyzed for the 249 surgeons each with ≥ 3 cases with prolonged extubation (76%, P < 0.0001).RESULTSThere were prolonged extubations for 23% (41,768/182,374) of cases. Prolonged extubations had a mean 13.3 min longer time from the end of surgery to OR exit (95% confidence interval 12.8-13.7 min, P < 0.0001). That result was among the 71 surgeons each with ≥ 9 cases having prolonged extubation times and ≥ 9 cases with typical extubation times. Results were similar using a threshold of ≥ 3 cases, comprising 257 surgeons (13.2 min, P < 0.0001). Among the 71 surgeons with at least nine prolonged extubations, on most days with a prolonged extubation during at least one of their cases, there were > 8 h of cases and turnover times in the OR (77%, 73%-81%, P < 0.0001). Results were similar when analyzed for the 249 surgeons each with ≥ 3 cases with prolonged extubation (76%, P < 0.0001).Matching earlier findings, prolonged tracheal extubation times are important economically, increasing OR time by 13 min and usually performed in ORs with lists of cases of sufficient duration to treat the extra time as a variable cost.CONCLUSIONSMatching earlier findings, prolonged tracheal extubation times are important economically, increasing OR time by 13 min and usually performed in ORs with lists of cases of sufficient duration to treat the extra time as a variable cost.

Economic impact of prolonged tracheal extubation times on operating room time overall and for subgroups of surgeons: a historical cohort study

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