Introduction: Although not traditionally examined, the nonoperative time a patient spends in the operating room is potentially significant. We determined the role of patient and procedure specific characteristics in nonoperative times in urology cases.
Methods: All patients at our tertiary institution had routine preoperative collection of patient and procedure specific data. Following institutional review board approval, we retrospectively reviewed the time landmarks of preoperative operating room time (the time from when the patient enters the room until the procedure starts) and postoperative operating room time (the time from the procedure end until the patient exits the room). Study inclusion criteria consisted of ASA™ (American Society of Anesthesiologists™) class I-IV and those cases with complete available data. Emergency cases (ASA score greater than 4) were excluded from analysis. Multivariable regression was used to assess the influence of patient and procedure variables on preoperative and postoperative operating room time.
Results: A total of 1,488 patients undergoing 1,786 urology procedures during a 9-month period (January to September 2016) met inclusion criteria. Following multivariable analysis, ASA class and Charlson comorbidity index were significantly associated with an increase in preoperative time. The only variable that had a significant association with preoperative and postoperative times was location (hospital vs ambulatory). Procedure type also had a significant effect on perioperative operating room times.
Conclusions: Our analysis is a novel approach to assessing operating room efficiency by characterizing the nonoperative time a patient spends in the operating room. Robotic cases have longer nonoperative times and increasing patient complexity prolongs preoperative time in the operating room. Better preparation of complex cases preoperatively will allow better use of constrained operating room resources.
Keywords: efficiency; operating rooms; operative time; quality improvement.