von Strauss Und Torney Marco, Dell-Kuster Salome, Hoffmann Henry, von Holzen Urs, Oertli Daniel, Rosenthal Rachel
Department of Surgery, University Hospital Basel, Basel, Switzerland.
Department of Surgery, Cantonal Hospital Aarau, 5001, Aarau, Switzerland.
Surg Endosc. 2016 Jun;30(6):2512-22. doi: 10.1007/s00464-015-4512-3. Epub 2015 Aug 27.
In the era of cost-constrained health care, optimal resource utilisation becomes fundamental in daily clinical practice. Currently, processes during surgery are poorly defined and workflows need to be scrutinised. This investigation aimed at identifying interruptions of surgical workflow and quantifying their impact on the duration of surgery and costs.
Interruptions of surgical workflow were defined as microcomplications (MC) and divided into the following subgroups: communication-related (CR), instrument changes (IC), missing instruments (MI), instrument failure (IF), waiting for a senior surgeon (SS), anaesthesia-related (AR) and position changes (PC). Audio-video records of laparoscopic cholecystectomies were reviewed regarding type, frequency and duration of MC. Risk factors for MC were investigated in a multivariable linear regression analysis. The costs of MC due to intraoperative delay were calculated.
Twenty audio-video records of laparoscopic cholecystectomies with a total duration of 28.9 h were reviewed. The median frequency of MC was 95 events/h with an overall duration of 452 min, corresponding to a delay of 15.6 min/h. Most frequent causes for MC were CR (32 events/h) and IC (54 events/h), leading to a total delay of 6.5 min/h for CR and 4.5 min/h for IC, respectively. MI and IF were less frequent (2.0 and 5.4 events/h), but single events lasted longer, resulting in a total delay of 1.4 min/h in MI and 2.1 min/h in IF. Intraoperative delays due to SS, AR or PC were rare. Multivariable regression analysis revealed previous abdominal surgery and cholecystitis as risk factors for a longer duration of MC (p = 0.004; p = 0.046). Based on OR minute costs of € 31.98, the delay due to MC led to additional costs of € 499/h.
MC cause relevant intraoperative delay and increased costs. Step-by-step protocols for a laparoscopic cholecystectomy may lead to a reduction in MC and should be further evaluated.
在医疗成本受限的时代，优化资源利用成为日常临床实践的基础。目前，手术过程定义不明确，工作流程需要仔细审查。本研究旨在识别手术工作流程中的干扰因素，并量化其对手术时长和成本的影响。
将手术工作流程中的干扰因素定义为微并发症（MC），并分为以下亚组：沟通相关（CR）、器械更换（IC）、器械缺失（MI）、器械故障（IF）、等待上级外科医生（SS）、麻醉相关（AR）和体位改变（PC）。回顾腹腔镜胆囊切除术的音频视频记录，以了解微并发症的类型、频率和持续时间。在多变量线性回归分析中研究微并发症的风险因素。计算因术中延迟导致的微并发症成本。
回顾了20份腹腔镜胆囊切除术的音频视频记录，总时长为28.9小时。微并发症的中位频率为95次/小时，总时长为452分钟，相当于每小时延迟15.6分钟。微并发症最常见的原因是CR（32次/小时）和IC（54次/小时），分别导致CR每小时总延迟6.5分钟和IC每小时总延迟4.5分钟。MI和IF频率较低（2.0次/小时和5.4次/小时），但单次事件持续时间较长，导致MI每小时总延迟1.4分钟，IF每小时总延迟2.1分钟。因SS、AR或PC导致的术中延迟很少见。多变量回归分析显示，既往腹部手术和胆囊炎是微并发症持续时间较长的风险因素（p = 0.004；p = 0.046）。基于每延迟一分钟成本为31.98欧元，微并发症导致的延迟每小时额外增加成本499欧元。
微并发症会导致术中出现相关延迟并增加成本。腹腔镜胆囊切除术的分步方案可能会减少微并发症，应进一步评估。
