Elisa Bianchi, MD1, Deborah S Keller, MS, MD2, Elizabeth Raskin, MD1. 1Loma Linda University Medical Center, 2Columbia University Medical Center
Background: Operating room (OR) time is an important quality measure, impacting patient outcomes and costs. Robotic assisted colorectal surgery (RACRS) has consistently longer reported OR times compared to laparoscopic and open surgery. However, with RACRS, where there are additional procedural components inherent in the case, OR inefficiencies- not actual operative time- may contribute to the additional time. We aimed to evaluate the components of OR time to identify for issues in workflow and reporting that may impact reported operative times.
Methods: A prospective innstitutional quality database was reviewed for elective RACRS cases at a tertiary referral facility from 10/2015 through 10/2017. Time reports for: OR entry, anesthesia start, procedure start, incision, docking, console, procedure stop, anesthesia finish, and OR exit times were evaluated. The main outcome measures were time spent in ancillary activities, operative time, and impediments to reporting and efficiency.
Results: During the time period, the defined time points for 60 cases were evaluated. “In Room” and “Anesthesia Start” times were recorded inaccurately, with 60% identical, and the remainder split between which occurred first. There were wide variations between “Procedure Start” and “Incision Time”, with an interval greater than 60 minutes in 7 cases. Long delays were also seen between “Anesthesia Start” and “Procedure Start” times. “Docking Time” and “Console Time” were a fraction of the total procedure time, and “Anesthesia Stop” time was more than an hour after “Procedure Stop”. A mean of 48 more minutes were required for “Out of Room” after “Anesthesia Stop” time.
Conclusions: Inconsistencies were identified in reporting, with lack of standardization over what periods define operative time. Longer OR times are not necessarily longer operative times. By standardizing these values and addressing inefficiencies, efforts can focus on improving reporting and quality for a cost-effective minimally invasive platform.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95032
Program Number: S161
Presentation Session: OR Efficiency & Outcomes
Presentation Type: Podium