Ou Ryan, Ramos Gianna, Bowles Cayley, Juo Yen-Yi, Shemin Richard J, Benharash Peyman
Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California.
Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California.
J Surg Res. 2017 Oct;218:348-352. doi: 10.1016/j.jss.2017.06.065. Epub 2017 Jul 22.
With the implementation of value-based health care, it is of increasing interest to understand whether performing elective surgeries during off-time impacts surgical outcomes. The objective of this study was to evaluate the impact of start times on nonemergent cardiac operations.
The institutional Society of Thoracic Surgeons was used to identify all adult nonemergent cardiac operations performed between January 2008 and December 2015 at our institution. "Off-time" is defined as either operation "late starts," that is, an incision time after 3 PM and before 7 AM, or procedures occurring during the weekends. Univariate and multivariate logistic regression analyses were performed to examine its impact on in-hospital mortality and major adverse events. Available cost data were directly obtained from the departmental BIOME database.
Of the 3406 cardiac operations included in the study, 2933 (86.1%) were normal-start and 473 (13.9%) were off-time-start operations. After adjusting for patient and operative characteristics, late operating room start times were not associated with increased in-hospital mortality (P = 0.28, confidence interval [CI] 95% = 0.99-1.03), readmissions (P = 0.21, CI 95% = 0.99-1.07), or major adverse events (P = 0.07, CI 95% = 1.00-1.12). In addition, there was no significant impact on total hospital cost (9.0% increase, P = 0.07).
These findings suggest that late operating room start times are not associated with increased mortality or other complications in a tertiary-care academic medical center. Our findings should be considered during operative scheduling to optimize resource distribution and patient care strategies.
随着基于价值的医疗保健的实施，了解非工作时间进行择期手术是否会影响手术结果变得越来越重要。本研究的目的是评估开始时间对非急诊心脏手术的影响。
利用机构胸外科医师学会来识别2008年1月至2015年12月在我们机构进行的所有成人非急诊心脏手术。“非工作时间”定义为手术“延迟开始”，即下午3点后至上午7点前的切口时间，或周末进行的手术。进行单因素和多因素逻辑回归分析，以检验其对住院死亡率和主要不良事件的影响。可用的成本数据直接从部门生物医学数据库获得。
在纳入研究的3406例心脏手术中，2933例（86.1%）为正常开始时间，473例（13.9%）为非工作时间开始的手术。在调整患者和手术特征后，手术室开始时间较晚与住院死亡率增加无关（P = 0.28，95%置信区间[CI] = 0.99 - 1.03）、再入院率（P = 0.21，CI 95% = 0.99 - 1.07）或主要不良事件（P = 0.07，CI 95% = 1.00 - 1.12）无关。此外，对总住院费用没有显著影响（增加9.0%，P = 0.07）。
这些发现表明，在三级学术医疗中心，手术室开始时间较晚与死亡率增加或其他并发症无关。在手术安排过程中应考虑我们的发现，以优化资源分配和患者护理策略。
