학술논문
The effect of an orthopedic specialty hospital on operating room efficiency in shoulder arthroplasty.
Document Type
Academic Journal
Author
Padegimas EM; Division of Shoulder and Elbow Surgery, The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.; Hendy BA; Division of Shoulder and Elbow Surgery, The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.; Chan WW; Division of Shoulder and Elbow Surgery, The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.; Lawrence C; Division of Shoulder and Elbow Surgery, The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.; Cox RM; Division of Shoulder and Elbow Surgery, The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.; Namdari S; Division of Shoulder and Elbow Surgery, The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.; Lazarus MD; Division of Shoulder and Elbow Surgery, The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.; Williams GR; Division of Shoulder and Elbow Surgery, The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.; Ramsey ML; Division of Shoulder and Elbow Surgery, The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.; Horneff JG; Division of Shoulder and Elbow Surgery, The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA. Electronic address: jghorneff3@gmail.com.
Source
Publisher: Mosby Country of Publication: United States NLM ID: 9206499 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-6500 (Electronic) Linking ISSN: 10582746 NLM ISO Abbreviation: J Shoulder Elbow Surg Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Operating room (OR) time is a major cost to the health care system. Therefore, increasing OR efficiency to save time may be a cost-saving tool. This study analyzed OR efficiency in shoulder arthroplasty at an orthopedic specialty hospital (OSH) and a tertiary referral center (TRC).
Methods: All primary shoulder arthroplasties performed at our OSH and TRC were identified (2013-2015). Manually matched cohorts from the OSH and TRC were compared for OR times. Three times (minutes) were recorded: anesthesia preparation time (APT; patient in room to skin incision), surgical time (ST; skin incision to skin closed), conclusion time (CT; skin closed to patient out of room).
Results: There were 136 primary shoulder arthroplasties performed at the OSH and matched with 136 at the TRC. OSH and TRC patients were similar in age (P = .95), body mass index (P = .97), Charlson Comorbidity Index (P = 1.000), sex (P = 1.000), procedure (P = 1.000), insurance status (P = .714), discharge destination (P = .287), and diagnoses (P = .354). These matched populations had similar ST (OSH: 110.0 ± 26.6 minutes, TRC: 113.4 ± 28.7 minutes; P = .307). APT (39.2 ± 8.0 minutes) and CT (7.6 ± 3.8 minutes) were shorter in the OSH patients than APT (46.3 ± 8.8 minutes; P < .001) and CT (11.2 ± 4.7 minutes; P < .001) in TRC patients. Total nonoperative time (sum of APT and CT) at the OSH (46.8 ± 8.9 minutes) was shorter than at the TRC (57.5 ± 10.4 minutes; P < .001).
Conclusions: Despite similar patient populations and case complexity, the OR efficiency at an OSH was superior to a TRC. Further analysis is needed to determine the financial implications of this superior OR efficiency.
(Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
Methods: All primary shoulder arthroplasties performed at our OSH and TRC were identified (2013-2015). Manually matched cohorts from the OSH and TRC were compared for OR times. Three times (minutes) were recorded: anesthesia preparation time (APT; patient in room to skin incision), surgical time (ST; skin incision to skin closed), conclusion time (CT; skin closed to patient out of room).
Results: There were 136 primary shoulder arthroplasties performed at the OSH and matched with 136 at the TRC. OSH and TRC patients were similar in age (P = .95), body mass index (P = .97), Charlson Comorbidity Index (P = 1.000), sex (P = 1.000), procedure (P = 1.000), insurance status (P = .714), discharge destination (P = .287), and diagnoses (P = .354). These matched populations had similar ST (OSH: 110.0 ± 26.6 minutes, TRC: 113.4 ± 28.7 minutes; P = .307). APT (39.2 ± 8.0 minutes) and CT (7.6 ± 3.8 minutes) were shorter in the OSH patients than APT (46.3 ± 8.8 minutes; P < .001) and CT (11.2 ± 4.7 minutes; P < .001) in TRC patients. Total nonoperative time (sum of APT and CT) at the OSH (46.8 ± 8.9 minutes) was shorter than at the TRC (57.5 ± 10.4 minutes; P < .001).
Conclusions: Despite similar patient populations and case complexity, the OR efficiency at an OSH was superior to a TRC. Further analysis is needed to determine the financial implications of this superior OR efficiency.
(Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)