高效与传统良性肛肠手术室工作日比较：一项队列研究

A comparison of high efficiency and traditional benign anorectal operating room days: a cohort study.

作者信息

Ricci Alessandro Leonardo, Patel Sunil, Brennan Kelly, Wiseman Vanessa, McKechnie Tyler, Farooq Ameer

机构信息

Division of General Surgery, Department of Surgery, Queen's University, 76 Stuart Street, Kingston, ON, K7L2V7, Canada.

Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.

出版信息

Surg Endosc. 2025 Jul 10. doi: 10.1007/s00464-025-11956-2.

DOI:10.1007/s00464-025-11956-2

PMID:40640618

Abstract

BACKGROUND

High efficiency (HE) operating rooms (OR) describe the intentional grouping of surgical cases according to case complexity, anesthetic, and nursing requirement. This approach has the potential to increase case volumes while protecting patient outcomes.

OBJECTIVE

Comparison of a HE to a Traditional model on surgical efficiency metrics, patient outcomes, and total costs in benign anorectal surgery.

METHODS

This single-center retrospective cohort study was conducted at a Canadian tertiary care academic center. Cases booked for the colorectal ambulatory surgical list during the pre-intervention (Traditional) phase spanning 2021-2022 were compared to the post-intervention (HE) phase implemented in 2023. The primary outcome of this study was surgical efficiency, defined as the number of cases completed per surgical list. Secondary outcomes included patient outcomes and hospital costs.

RESULTS

257 patients were included in this study (Traditional 125 cases in 24 OR lists, HE 132 cases in 19 OR lists). Mean age (Traditional 52.2 vs. HE 49.1, p = 0.130) and male sex (57.6% vs. 56.8%, p = 0.899) were similar between groups. In the HE phase, more benign anorectal cases were completed per day (5.2 cases vs. 6.9cases, p < 0.001). The HE model saved 13 min (72.0 min vs 59.7 min, p < 0.001) per case. This included a decrease in surgical time (26.8 min vs. 21.3 min, p = 0.069), anesthetic time (20.2 min vs. 16.3 min, p < 0.001), and turnover time (22.6 min vs.18.5 min, p < 0.001). Perioperative outcomes, such as total PACU time (87.3 min vs 103.2 min, p = 0.080) and time to discharge (72.8 min vs 82.5 min, p = 0.262), were similar between phases. A HE model resulted in cost savings of approximately $368.13 per case ($1575 vs. $1207, p = 0.0013).

CONCLUSION

Implementation of a HE model resulted in more cases being completed, similar patient outcomes, and decreased costs of care. Adoption of this model should be considered for non-complex surgical procedures, especially in resource-limited settings.

摘要

背景

高效（HE）手术室是指根据病例复杂性、麻醉和护理需求对手术病例进行有意分组。这种方法有可能增加病例数量，同时保障患者的治疗效果。

目的

比较高效模式与传统模式在良性肛肠手术中的手术效率指标、患者治疗效果及总成本。

方法

本单中心回顾性队列研究在加拿大一家三级医疗学术中心进行。将2021 - 2022年干预前（传统）阶段安排在结直肠门诊手术清单上的病例与2023年实施的干预后（高效）阶段的病例进行比较。本研究的主要结局是手术效率，定义为每个手术清单完成的病例数。次要结局包括患者治疗效果和医院成本。

结果

本研究纳入了257例患者（传统模式下24个手术清单中有125例，高效模式下19个手术清单中有132例）。两组患者的平均年龄（传统模式52.2岁 vs. 高效模式49.1岁，p = 0.130）和男性比例（57.6% vs. 56.8%，p = 0.899）相似。在高效阶段，每天完成的良性肛肠病例更多（5.2例 vs. 6.9例，p < 0.001）。高效模式每例节省13分钟（72.0分钟 vs 59.7分钟，p < 0.001）。这包括手术时间减少（26.8分钟 vs. 21.3分钟，p = 0.069）、麻醉时间减少（20.2分钟 vs. 16.3分钟，p < 0.001）和周转时间减少（22.6分钟 vs.18.5分钟，p < 0.001）。围手术期结局，如总PACU时间（87.3分钟 vs 103.2分钟，p = 0.080）和出院时间（72.8分钟 vs 82.5分钟，p = 0.262），在两个阶段相似。高效模式使每例成本节省约368.13美元（1575美元 vs. 1207美元，p = 0.0013）。