Journal article
Variability of the times remaining in surgical cases and the importance of knowing when closure has started
Perioperative care and operating room management, Vol.30, 100299
03/2023
DOI: 10.1016/j.pcorm.2022.100299
Abstract
When a patient enters the operating room, the projected time to room exit is the time of room entry plus the estimated case duration. Subsequent estimates are provided based on a probability distribution for time remaining in the case, conditional on the interval from room entry. There have been several recent studies investigating and showing good accuracy of different suitable methods. However, it is unknown whether and why these methods are useful compared with the historical data and original surgeon/ scheduler estimate known before the case started. We hypothesized that knowing when closure has started, patient has been extubated, etc., gives substantive incremental information.
Our retrospective cohort study included all 23,343 surgical cases at a large hospital over 4.2 years wherein each case's surgeon scheduled the procedure ≥29 times. The sample size was n = 244 combinations of scheduled Current Procedural Terminology code and surgeon.
Variability in the logarithmic scale (i.e., proportional variability in the time scale) increased progressively as cases advanced. Specifically, the 90th percentiles of times to operating room exit were ≈40% longer than 50th percentiles (medians) at the start of cases versus 142% longer at the time of the start of closure. These ratios were less at starts of cases than at closures for 99.2% of n = 244 combinations (P <0.0001). The 5th percentiles were ≈32% briefer than 50th percentiles at the start of cases versus 85% briefer at the time of the start of closure. These ratios were less at starts of cases than at closures for 100% of combinations (P <0.0001).
There is considerable information value in knowing when key milestones have occurred near the end of cases that managers can use for quality decision-making (e.g., when closure has started). Organizations should document these milestones in real-time.
Details
- Title: Subtitle
- Variability of the times remaining in surgical cases and the importance of knowing when closure has started
- Creators
- Franklin Dexter - University of Iowa, Iowa City, IA, United StatesJohannes Ledolter - University of IowaSarah S. Titler - University of IowaRichard H. Epstein - University of Miami
- Resource Type
- Journal article
- Publication Details
- Perioperative care and operating room management, Vol.30, 100299
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.pcorm.2022.100299
- ISSN
- 2405-6030
- eISSN
- 2405-6030
- Language
- English
- Date published
- 03/2023
- Academic Unit
- Business Analytics; Health Management and Policy; Anesthesia; Stead Family Department of Pediatrics; Statistics and Actuarial Science
- Record Identifier
- 9984321876802771
Metrics
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