Research on Healthcare Performance RESHAPE, Inserm U1290, Université Claude Bernard Lyon 1, Lyon, France.
Department of Digestive Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
BJS Open. 2024 Sep 3;8(5). doi: 10.1093/bjsopen/zrae117.
A surgeon's daily performance may be affected by operating room organizational factors, potentially impacting patient outcomes. The aim of this study was to investigate the link between a surgeon's exposure to delays in starting scheduled operations and patient outcomes.
A prospective observational study was conducted from 1 November 2020 to 31 December 2021, across 14 surgical departments in four university hospitals, covering various surgical disciplines. All elective surgeries by 45 attending surgeons were analysed, assessing delays in starting operations and inter-procedural wait times exceeding 1 or 2 h. The primary outcome was major adverse events within 30 days post-surgery. Mixed-effect logistic regression accounted for operation clustering within surgeons, estimating adjusted relative risks and outcome rate differences using marginal standardization.
Among 8844 elective operations, 4.0% started more than 1 h late, associated with an increased rate of adverse events (21.6% versus 14.4%, P = 0.039). Waiting time surpassing 1 h between procedures occurred in 71.4% of operations and was also associated with a higher frequency of adverse events (13.9% versus 5.3%, P < 0.001). After adjustment, delayed operations were associated with an elevated risk of major adverse events (adjusted relative risk 1.37 (95% c.i. 1.06 to 1.85)). The standardized rate of major adverse events was 12.1%, compared with 8.9% (absolute difference of 3.3% (95% c.i. 0.6% to 5.6%)), when a surgeon experienced a delay in operating room scheduling or waiting time between two procedures exceeding 1 h, as opposed to not experiencing such delays.
A surgeon's exposure to delay before starting elective procedures was associated with an increased occurrence of major adverse events. Optimizing operating room turnover to prevent delayed operations and waiting time is critical for patient safety.
手术医生的日常表现可能受到手术室组织因素的影响，从而潜在影响患者的结局。本研究旨在探讨手术医生在开始预定手术时出现延误与患者结局之间的关联。
这是一项于 2020 年 11 月 1 日至 2021 年 12 月 31 日在四家大学医院的 14 个外科科室进行的前瞻性观察研究，涵盖了各种外科专业。分析了 45 名主治外科医生的所有择期手术，评估了手术开始时间的延误以及超过 1 或 2 小时的术间等待时间。主要结局为术后 30 天内的重大不良事件。混合效应逻辑回归考虑了手术医生内的手术聚类，使用边缘标准化估计调整后的相对风险和结局率差异。
在 8844 例择期手术中，有 4.0%的手术开始时间延迟超过 1 小时，与不良事件发生率增加相关（21.6%比 14.4%，P = 0.039）。手术间等待时间超过 1 小时的情况发生在 71.4%的手术中，也与更高的不良事件发生率相关（13.9%比 5.3%，P < 0.001）。调整后，手术延迟与重大不良事件的风险升高相关（调整后的相对风险 1.37（95%可信区间 1.06 至 1.85））。与手术医生在手术室安排或手术间等待时间方面没有经历 1 小时以上的延误相比，当手术医生经历手术室安排或手术间等待时间超过 1 小时的延误时，重大不良事件的标准化发生率为 12.1%，而不是 8.9%（绝对差值为 3.3%（95%可信区间 0.6%至 5.6%））。
手术医生在开始择期手术前出现延误与重大不良事件的发生增加相关。优化手术室周转以防止手术延误和等待时间过长对于患者安全至关重要。
