Department of Anesthesiology, Perioperative Medicine & Pain Management, University of Miami, Miller School of Medicine, 1400 NW 12th Avenue, Suite 4022, Miami, Florida 33136, United States of America.
Division of Management Consulting, Department of Anesthesia, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242, United States of America.
J Clin Anesth. 2021 Dec;75:110432. doi: 10.1016/j.jclinane.2021.110432. Epub 2021 Jul 16.
Operating room (OR) utilization has been shown in multiple studies to be an inappropriate metric for planning OR time for individual surgeons. Among surgeons with low daily caseloads, percentage utilization cannot be measured accurately because confidence limits are extremely wide. In Iowa, a largely rural state, most surgeons performed only 1 or 2 elective cases on their OR days. To assess generalizability, we analyzed Florida, a state with many high-population density areas.
Observational cohort study.
The 602 facilities in Florida that performed inpatient or outpatient elective surgery from January 2010 through December 2019.
The providers licensed to perform surgery in Florida (physician, oral surgeons, dentists, and podiatrists) were identified by their national provider number. Hospitals were deidentified before analysis.
The primary endpoint was the mean among facilities in percentages of surgeon-day combinations ("lists") containing 1 or 2 cases. Proportions were calculated using Freeman-Tukey transformation and the harmonic mean of the number of lists at each facility. Comparison to "most" (>50%) used Student's two-sided one-group t-test.
Averaging among hospitals, most surgeons' lists included 1 or 2 cases (64.4%; 99% confidence interval [CI] 61.3%-67.4%) P < 0.00001). Many lists had 1 case (44.2%, 99% CI 41.2%-47.2%). Nearly all (96.7%) surgeons operated at just one hospital on their OR days.
Most surgeons' lists of elective surgical cases comprised 1 or 2 cases in the largely urban state of Florida, as previously found in the largely rural state of Iowa. Results were insensitive to organizational size or county population. Thus, our finding is generalizable in the United States. Consequently, neither adjusted nor raw utilization should be used solely when allocating OR time to individual surgeons. Anesthesia and nursing coverage of cases can be based on maximizing the efficiency of use of OR time.
多项研究表明，手术室（OR）利用率作为规划单个外科医生 OR 时间的指标并不合适。在每日手术量较低的外科医生中，由于置信区间极宽，无法准确测量使用率。在爱荷华州，一个以农村为主的州，大多数外科医生在他们的手术室日只进行 1 到 2 例择期手术。为了评估普遍性，我们分析了佛罗里达州，一个人口密度较高的地区。
观察性队列研究。
2010 年 1 月至 2019 年 12 月期间，佛罗里达州 602 家进行住院或门诊择期手术的设施。
通过其国家提供者编号确定在佛罗里达州有手术资格的提供者（医生、口腔外科医生、牙医和足病医生）。在分析之前，医院被去识别。
主要终点是设施间包含 1 或 2 例手术的外科医生日组合（“列表”）的平均值。使用 Freeman-Tukey 变换和每个设施的列表数量的调和平均值计算比例。使用学生双侧单组 t 检验与“大多数”（>50%）进行比较。
平均而言，大多数外科医生的列表中包含 1 或 2 例手术（64.4%；99%置信区间[CI] 61.3%-67.4%），P<0.00001）。许多列表中有 1 例（44.2%，99%CI 41.2%-47.2%）。几乎所有（96.7%）外科医生在他们的手术室日都只在一家医院进行手术。
在以城市为主的佛罗里达州，大多数外科医生的择期手术列表中包含 1 或 2 例手术，这与以农村为主的爱荷华州的先前发现一致。结果对组织规模或县人口不敏感。因此，我们的发现在美国具有普遍性。因此，在分配手术室时间给个别外科医生时，既不应单独使用调整后的利用率，也不应单独使用原始利用率。可以基于最大限度地提高手术室时间利用效率来安排麻醉和护理覆盖范围。
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