Luthra Suvitesh, Ramady Omar, Monge Mary, Fitzsimons Michael G, Kaleta Terry R, Sundt Thoralf M
Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Division of Cardiac Anesthesia, Massachusetts General Hospital, Boston, Massachusetts.
J Card Surg. 2015 Jun;30(6):477-87. doi: 10.1111/jocs.12528. Epub 2015 Apr 13.
Markers of operation room (OR) efficiency in cardiac surgery are focused on "knife to skin" and "start time tardiness." These do not evaluate the middle and later parts of the cardiac surgical pathway. The purpose of this analysis was to evaluate knife to skin time as an efficiency marker in cardiac surgery.
We looked at knife to skin time, procedure time, and transfer times in the cardiac operational pathway for their correlation with predefined indices of operational efficiency (Index of Operation Efficiency - InOE, Surgical Index of Operational Efficiency - sInOE). A regression analysis was performed to test the goodness of fit of the regression curves estimated for InOE relative to the times on the operational pathway.
The mean knife to skin time was 90.6 ± 13 minutes (23% of total OR time). The mean procedure time was 282 ± 123 minutes (71% of total OR time). Utilization efficiencies were highest for aortic valve replacement and coronary artery bypass grafting and least for complex aortic procedures. There were no significant procedure-specific or team-specific differences for standard procedures. Procedure times correlated the strongest with InOE (r = -0.98, p < 0.01). Compared to procedure times, knife to skin is not as strong an indicator of efficiency. A statistically significant linear dependence on InOE was observed with "procedure times" only.
Procedure times are a better marker of OR efficiency than knife to skin in cardiac cases. Strategies to increase OR utilization and efficiency should address procedure times in addition to knife to skin times.
心脏手术中手术室（OR）效率的指标主要集中在“切皮时间”和“开始时间延迟”。这些指标并未评估心脏手术流程的中后段。本分析的目的是评估切皮时间作为心脏手术效率指标的情况。
我们研究了心脏手术流程中的切皮时间、手术时间和转运时间，以确定它们与预先定义的手术效率指标（手术效率指数 - InOE、手术操作效率外科指数 - sInOE）之间的相关性。进行回归分析以检验针对InOE估计的回归曲线与手术流程时间的拟合优度。
平均切皮时间为90.6±13分钟（占手术室总时间的23%）。平均手术时间为282±123分钟（占手术室总时间的71%）。主动脉瓣置换术和冠状动脉搭桥术的利用效率最高，复杂主动脉手术的利用效率最低。标准手术在手术特定或团队特定方面没有显著差异。手术时间与InOE的相关性最强（r = -0.98，p < 0.01）。与手术时间相比，切皮时间作为效率指标的关联性没那么强。仅观察到“手术时间”与InOE存在统计学上显著的线性相关性。
在心脏手术病例中，手术时间比切皮时间更能作为手术室效率的指标。提高手术室利用率和效率的策略除了关注切皮时间外，还应关注手术时间。
