Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Surgery. 2011 Aug;150(2):299-305. doi: 10.1016/j.surg.2011.05.005.
Financial pressures drive efforts to optimize hospital resource use, but inefficiencies occur in systems as volume nears total capacity. We examined how operating room use impacts efficiency and costs of treating an urgent surgical condition.
A retrospective review of patients who underwent appendectomy for appendicitis at a single hospital from 2004 to 2009 was performed. Patient demographics, operative characteristics, pathologic diagnoses, hospital time intervals, and costs were analyzed. Gap time (time from case booking to surgery start) was used to measure operating room availability.
In all, 453 patients met inclusion criteria. Longer gap times were associated with increased hospital-based costs. A gap time of greater than 2 h was associated with 39% higher costs to the hospital, which could not be accounted for by any single cost center. The patients in the 2 groups had similar medical and surgical complexity, as well as similar clinical outcomes and hospital duration of stay. Gap times were greatest during peak elective operating room activity (7 am to 11 pm); however, the total hospital costs were not related to the time of day of the case.
A short delay in operating room availability for urgent cases is associated with significantly increased total hospital costs. Our data suggest this finding is attributable to inefficient care when the operating room volume nears total capacity.
财务压力促使医院努力优化资源利用，但当容量接近总容量时，系统会出现效率低下的情况。我们研究了手术室的使用如何影响治疗紧急手术情况的效率和成本。
对 2004 年至 2009 年期间在一家医院接受阑尾切除术治疗阑尾炎的患者进行了回顾性研究。分析了患者的人口统计学特征、手术特点、病理诊断、医院时间间隔和成本。间隙时间（从病例预订到手术开始的时间）用于衡量手术室的可用性。
共有 453 名患者符合纳入标准。较长的间隙时间与医院基础成本的增加有关。间隙时间超过 2 小时与医院成本增加 39%相关，这不能归因于任何单一的成本中心。这两组患者的医疗和手术复杂性相似，临床结果和住院时间也相似。在高峰期（上午 7 点至晚上 11 点）手术室的选择活动间隙时间最长；然而，病例的发生时间与总医院成本无关。
紧急情况下手术室可用性的短暂延迟与总医院成本的显著增加有关。我们的数据表明，这一发现归因于当手术室容量接近总容量时护理效率低下。
