Kadhim Muayad, Gans Itai, Baldwin Keith, Flynn John, Ganley Theodore
Division of Orthopaedic Surgery, the Children's Hospital of Philadelphia, PA.
J Pediatr Orthop. 2016 Jun;36(4):423-8. doi: 10.1097/BPO.0000000000000454.
The aim of this study was to examine the differences in primary anterior cruciate ligament reconstruction (ACLR) surgical time and operation room (OR) work efficiency between inpatient and ambulatory facilities within the same institution.
Patients studied included those who underwent primary ACLR at either the inpatient hospital or the ambulatory facility by a single orthopaedic surgeon on elective surgery days. Time variables were calculated for ACLR to compare the 2 facilities. The OR work efficiency was calculated as the percentage of work that was completed before mid-day that was determined by the midpoint of the surgical day at each facility.
Two hundred twenty-seven ACLR surgeries were performed on 187 elective surgery days, 153 surgeries at the inpatient facility and 74 at the outpatient facility. The mean age at the time of surgery was 14.9±2.2 years. The ACLR surgeries at the ambulatory facility were of shorter duration than those at the inpatient facility (P<0.0001). One OR was most commonly utilized and 2 to 3 surgeries were performed on most surgery days at both facilities. Seven nurses served as alternating circulators at the ambulatory facility compared with 41 nurses serving in the same capacity at the inpatient facility. The median turnover time was longer at the inpatient facility compared with the ambulatory facility. OR work efficiency (work done before mid-day) was 72.5% at the ambulatory facility and 49.5% at the inpatient facility, P<0.0001. If 2 ACLR surgeries were performed consecutively, the surgery day lasted for 6 hours at the hospital-owned ambulatory surgery center compared with 9 hours at the inpatient hospital.
Despite the common variables of the same surgeon performing the same surgery at facilities owned by the same institution primarily working in a single OR, differences exist in OR procedure time and work efficiency.
Level III.
本研究旨在探讨同一机构内住院部和门诊机构在初次前交叉韧带重建（ACLR）手术时间和手术室（OR）工作效率方面的差异。
研究对象包括在择期手术日由同一位骨科医生在住院医院或门诊机构接受初次ACLR的患者。计算ACLR的时间变量以比较这两个机构。手术室工作效率通过各机构手术日中点之前完成的工作量占比来计算。
在187个择期手术日共进行了227例ACLR手术，其中住院机构153例，门诊机构74例。手术时的平均年龄为14.9±2.2岁。门诊机构的ACLR手术持续时间比住院机构短（P<0.0001）。两个机构最常使用一间手术室，大多数手术日进行2至3台手术。门诊机构有7名护士轮流担任巡回护士，而住院机构有41名护士担任同样的工作。住院机构的平均周转时间比门诊机构长。手术室工作效率（中午前完成的工作）在门诊机构为72.5%，在住院机构为49.5%，P<0.0001。如果连续进行两台ACLR手术，医院所属门诊手术中心的手术日持续6小时，而住院医院则为9小时。
尽管在同一机构所属设施中由同一位外科医生进行相同手术，且主要在一间手术室工作等变量相同，但手术室手术时间和工作效率仍存在差异。
三级。
