Coffin Elisabeth M O, Poloni Dana, Burgess Pamela
Department of General Surgery, Dwight D Eisenhower Army Medical Center, 300 East Hospital Road, Fort Gordon, Augusta, GA, 30905, USA.
Surg Endosc. 2023 Jan;37(1):653-659. doi: 10.1007/s00464-022-09478-2. Epub 2022 Sep 6.
Army medical treatment facilities (MTFs) use a surgery scheduling system that reviews historical OR times to dictate expected procedural time when posting new cases. At a single military institution there was a noted inflation to umbilical hernia repair (UHR) times that was leading to issues with under-utilized operating rooms.
This is a retrospective review determining what variables correlate with longer UHR operative time. Umbilical, ventral, epigastric, and incisional hernia repairs (both open and laparoscopic) were pulled from the local OR scheduling system at Dwight D. Eisenhower Army Medical Center from January 2013 to June 2018.
A total of 442 patients were included in the study with a mean age of 45.74 years and 54.98% male. Patient ASA level (p 0.045), primary vs. mesh repair (p < 0.001), number of hernias repaired (p 0.05), hernia size (p < 0.001), and absence of student nurse anesthetist (SRNA) (p 0.05) all correlated with longer UHR OR times. For the aggregated open hernia repair data, almost all independent variables of interest were statistically significant including age, PGY level, history of DM, case acuity, presence of SRNA, patient ASA level, patient's BMI, hernia defect size, number of hernias, history of prior repair, and history prior abdominal surgery. Multivariate regression analysis was done on the open hernia repair variables with only age and size of hernia being significant.
This data were used to create a new case request option (open UHR without mesh and open UHR with mesh) to more effectively utilize available OR time.
军队医疗设施（MTF）使用一种手术调度系统，该系统会回顾历史手术时间，以便在安排新病例时确定预期的手术时间。在一家军事机构中，脐疝修补术（UHR）时间出现了明显的延长，这导致手术室利用不足的问题。
这是一项回顾性研究，旨在确定哪些变量与较长的UHR手术时间相关。2013年1月至2018年6月期间，从德怀特·D·艾森豪威尔陆军医疗中心的当地手术调度系统中提取了脐疝、腹疝、上腹部疝和切口疝修补术（包括开放手术和腹腔镜手术）的数据。
共有442名患者纳入研究，平均年龄45.74岁，男性占54.98%。患者的美国麻醉医师协会（ASA）分级（p = 0.045）、初次修补与补片修补（p < 0.001）、修补的疝数量（p = 0.05）、疝大小（p < 0.001）以及没有学生护士麻醉师（SRNA）（p = 0.05）均与较长的UHR手术时间相关。对于汇总的开放疝修补数据，几乎所有感兴趣的自变量都具有统计学意义，包括年龄、住院医师培训水平、糖尿病史、病例严重程度、SRNA的存在、患者ASA分级、患者体重指数（BMI）、疝缺损大小、疝数量、既往修补史和既往腹部手术史。对开放疝修补变量进行多变量回归分析，只有年龄和疝大小具有显著性。
这些数据被用于创建一个新的病例请求选项（无补片的开放UHR和有补片的开放UHR），以更有效地利用可用的手术时间。
