Time between Patient Arrival to Operating Room and Incision for Intracranial Hematoma Evacuation
Zhihao Zhu, Mr. Anthony V Nguyen, Dr. Rishi Lall
University of Texas Medical Branch School of Medicine
Introduction: A variety of factors can affect the efficiency and amount of time in operating rooms. These are critical drivers of institutional costs and productivity. In selected patient populations, especially emergent cases, the operating room times, and potential delays, can be strongly correlated to patient outcomes. The time between when a patient arrives in an operating room to the incision time is one significant fraction of the overall operating room time. In this study, we investigate the effects of various variables on this time between patient arrival to operating room and incision for cases of intracranial hematoma evacuation.
Methods: This was a single center retrospective case series conducted at our institution. We reviewed all patient charts from January 2013 to April 2016 for cases of intracranial hematoma performed by a neurosurgeon continuously employed at our institution at the time. The time between patient arrival to operating room and incision was extracted, along with other demographic and perioperative variables including patient age, sex, identity of attending surgeon, number of surgical residents, number of anesthesia attendings, number of anesthesia residents/CRNAs, whether the case was performed overnight, day of the week, wound class, which antibiotics were used, estimated blood loss, and whether the case was from emergency department or inpatient. A multivariate generalized linear model (GLM), implemented in R, was used to analyze the effect of each of these variables on the time between patient arrival to operating room and incision.
Results: We identified 92 total cases that met the criteria. The mean for time from patient arrival to operating room to incision for all cases was 33.0(SD 15.4) minutes. From the results of the multivariate GLM analysis, the only statistically significant variable was the number of anesthesia attendings in the case, which was an estimated decrease of 9.79(SE 4.24) minutes for each additional attending (P< 0.0245). The number of surgery residents was associated with estimated decreased of 7.78(SE 4.50) minutes for each additional resident(P< 0.0883).
Conclusion: This study shows that increasing the number of anesthesia attending in the case significantly decreases the amount of time between patient arrival to the operating room and incision for intracranial hematoma evacuation. This finding may help guide future operating room protocol and management.