A. Clark1, J. L. Rabaglia1, A. P. Dackiw1, W. D. White1, F. Nwariaku1, S. A. Holt1, S. C. Oltmann1 1University Of Texas Southwestern Medical Center,Dallas, TX, USA
Introduction
Some surgical cases involve complex, pre-incision preparation in the operating room(OR). When a consistent team is not available, and/or when multiple trainees are involved, oversight by an experienced individual can facilitate a timely start. Thyroid, parathyroid and adrenal procedures represent cases in which patient positioning, ultrasonography, nerve monitoring, and/or vascular access for hormone measurements during the procedure may occur before the operation can start. The study hypothesized that early attending presence in the OR expedites surgery start time, improving OR efficiency and decreasing cost.
Methods
Patients undergoing thyroid, parathyroid or adrenal procedures at an urban teaching hospital were selected. Time points were recorded, and calculated as hours:minutes. Cost per minute (m) of OR time was $54. Patients were classified as in the OR ≤10m prior to attending arrival or >10m prior to attending arrival. Data are presented as mean ± SD.
Results
227 cases were performed over 14 months. Thyroidectomy was most common (n=166, 73%), with 54 parathyroid (25%) and 10 adrenal (4.4%) procedures. Combined thyroid and parathyroid procedures occured for 7. 89% were female patients, and a mean age 48±15.
128 patients (56%) were in the OR ≤10m prior to attending arrival and 99 patients (44%) were >10m (0:03±3 vs. 0:35±14, p<0.01). Gender distribution was equivalent (p=1.0). ≤10m patients were older (50±15 vs. 46±14, p=0.04). Adrenal cases were equivalent (5% vs. 4%, p=1), while ≤10m included more parathyroid (32% vs. 15%, p<0.01) and fewer thyroid cases (66% vs. 82%, p<0.01).
≤10m procedures started sooner after patient arrival in OR (0:40±11 vs. 1:03±19, p<0.01). Associated OR costs per minute were $2,206±614 vs. $3,430±1065 (p<0.01), or $1,202 savings before the operation even began in the ≤10m group.
Adrenal and parathyroid had equivalent attending time in the OR prior incision between ≤10m and >10m (p=0.98 and p=0.80). However, patient time in OR prior incision for adrenal cases (0:58±7 vs. 1:42±30, p<0.01) and parathyroid cases (0:39±9 vs. 1:06±13, p<0.01) were shorter in the ≤10m group. This equates to $2,416±477 in savings for adrenal and $1,458±244 for parathyroid cases. For thyroid, attending time in OR prior incision was longer in ≤10m than >10m (0:37±11 vs. 0:24±14, p<0.01), but cases still started sooner (0:40±11 vs. 1:00±17, p<0.01). This equates to $1076±120 in savings per thyroidectomy.
Conclusion
Early attending presence in the OR shortens time to incision, decreasing costs. For parathyroid and adrenal cases, this does not require additional time from the attending surgeon. In ORs without consistent teams or with multiple trainees, early attending presence in the OR improves OR efficiency and results in significant cost savings.