Padegimas Eric M, Hendy Benjamin A, Lawrence Cassandra, Devasagayaraj Richard, Zmistowski Benjamin M, Abboud Joseph A, Lazarus Mark D, Williams Gerald R, Namdari Surena
Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
J Shoulder Elbow Surg. 2017 Jun;26(6):1058-1063. doi: 10.1016/j.jse.2016.11.040. Epub 2017 Jan 25.
A significant portion of operating room time in shoulder arthroplasty is devoted to nonsurgical tasks. To maximize efficiency and to increase access to care, it is important to accurately quantify surgical and nonsurgical time for shoulder arthroplasty. This study aimed to evaluate surgical vs. nonsurgical time and to assess the viability of using a 1-surgeon, 2-operating room model.
An institutional database was used to identify all primary and revision shoulder arthroplasty cases from February 2011 through December 2013. Time intervals were analyzed, including anesthesia and positioning time, surgical time, conclusion time, and turnover time.
We identified 1062 shoulder arthroplasties. The average anesthesia and positioning time was 48.2 ± 11.7 minutes, surgical time was 122.7 ± 36.4 minutes, and conclusion time was 10.5 ± 7.0 minutes. Average turnover time at our institution was 40 minutes. An average of 58.8 ± 13.8 minutes (33.2%) of the patient's time in the operating room was not surgical. A 1-room surgical model, with each case following the next, would allow 3 arthroplasties to be performed in a 10-hour surgical day. A 2-room model would allow 4 cases to be performed in a 9-hour surgical day or 5 in an 11-hour day. In this 2-room model, there would be no time in which the surgeon is absent for any surgical portion of the case.
For a high-volume shoulder arthroplasty practice, a 2-room model leads to greater efficiency and patient access to care without sacrificing the surgeon's presence during surgical portions of the case.
肩关节置换术中相当一部分手术室时间用于非手术任务。为了最大限度地提高效率并增加医疗服务的可及性，准确量化肩关节置换术的手术时间和非手术时间非常重要。本研究旨在评估手术时间与非手术时间，并评估采用一名外科医生、两个手术室模式的可行性。
使用机构数据库识别2011年2月至2013年12月期间所有初次和翻修肩关节置换病例。分析了时间间隔，包括麻醉和摆位时间、手术时间、结束时间和周转时间。
我们识别出1062例肩关节置换术。平均麻醉和摆位时间为48.2±11.7分钟，手术时间为122.7±36.4分钟，结束时间为10.5±7.0分钟。我们机构的平均周转时间为40分钟。患者在手术室的时间中平均有58.8±13.8分钟（33.2%）不是手术时间。单室手术模式下，每个病例依次进行，在10小时的手术日可进行3例置换术。双室模式在9小时的手术日可进行4例手术，或在11小时的手术日进行5例手术。在这种双室模式下，在病例的任何手术部分都不会出现外科医生不在场的情况。
对于大量肩关节置换术的实践，双室模式可提高效率并增加患者获得医疗服务的机会，同时在病例的手术部分不会牺牲外科医生的在场时间。
