Department of Anesthesia, University of Iowa, Iowa City, IA 52242, USA.
Anesth Analg. 2010 Apr 1;110(4):1164-8. doi: 10.1213/ANE.0b013e3181cd6eb9. Epub 2010 Feb 9.
Surgeon estimates of case durations are important for operating room (OR) management decision making because many cases are rare combinations of procedures with few or no historical data. Thoracic and spine surgeons updated their scheduled OR times on the day of surgery just before the "time out" in the OR.
All elective (scheduled) general thoracic (n = 39) and spine surgery (n = 48) cases at 1 hospital were studied over 3-month and 1.5-month periods, respectively.
Among cases with a change in predicted duration, most changes were made based on updates to the surgical or anesthetic procedures (thoracic 85%, spine 86%). For thoracic surgery, there was overall no significant median reduction in absolute prediction error (median 0 minutes, 95% confidence interval [CI] 0-0 minutes). Among the 37% of cases with changed predicted durations, there was a significant reduction in absolute error (median 38 minutes, 95% CI >7.5 minutes). For spine surgery, there was overall no reduction in the absolute error (median 0 minutes, 95% CI 0-0 minutes). Among the 29% of cases with changed predicted durations, absolute error was no worse, but not significantly better (point estimate of median reduction 34 minutes, 95% CI >0 minutes). Secondary observations made were no effect of updates on bias, frequent rounding of scheduled durations to the nearest half hour, and increased predictive error caused by decisions that reduced expected overutilized OR time.
A systematic program of routinely and/or always asking for updated case duration predictions will not substantively improve OR management decision making. However, when a change in surgical approach, surgical procedure, or anesthetic procedure is identified (e.g., at the intraoperative briefing before case start), the updated estimate of case duration should be used, because such updates are not worse and often better than original estimates.
外科医生对手术时间的预估对于手术室（OR）管理决策非常重要，因为许多手术都是程序罕见组合，且几乎没有历史数据。胸外科和脊柱外科医生在手术当天的“暂停”前更新他们计划的 OR 时间。
在一家医院，分别对 3 个月和 1.5 个月的时间段内所有择期（计划）普通胸科（n=39）和脊柱手术（n=48）病例进行了研究。
在手术时间预测发生变化的病例中，大多数变化是基于手术或麻醉程序的更新（胸外科 85%，脊柱外科 86%）。对于胸外科手术，总体上绝对预测误差中位数没有显著减少（中位数 0 分钟，95%置信区间 [CI] 0-0 分钟）。在预测时间发生变化的 37%的病例中，绝对误差显著减少（中位数 38 分钟，95%CI>7.5 分钟）。对于脊柱外科手术，绝对误差中位数没有减少（中位数 0 分钟，95%CI 0-0 分钟）。在预测时间发生变化的 29%的病例中，绝对误差没有更糟，但也没有显著改善（中位数减少 34 分钟的点估计值，95%CI>0 分钟）。次要观察结果为更新对偏差没有影响，手术时间的计划时长经常四舍五入到最近的半小时，以及由于减少预计过度利用 OR 时间的决策而导致预测误差增加。
系统地定期或始终要求更新手术时间预测的程序不会实质性地改善手术室管理决策。但是，当识别出手术方法、手术程序或麻醉程序的变化时（例如，在手术开始前的术中简报中），应使用手术时间的更新估计值，因为这些更新并不比原始估计值更差，而且通常更好。
