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Late Operating Room Start Times Impact Mortality and Cost for Nonemergent Cardiac Surgery.

ABSTRACT: There is growing concern over the effect of starting non-emergent cardiac surgery later in the day on clinical outcomes and resource utilization. Our objective was to determine the differences in patient outcomes for starting non-emergent cardiac surgery after 3 pm.All non-emergent cardiac operations performed at a single institution from July 2008 to 2013 were reviewed. Cases were stratified based on "early start" or "late start," defined by incision time before or after 3 pm. Rates of observed and risk-adjusted mortality, major complications, and costs were compared on a univariate basis for all patients and by multivariable linear and logistic regression for patients with a valid The Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (PROM).A total of 3,395 non-emergent cardiac operations were reviewed, including 368 late start cases. Compared with cases starting earlier, mortality was significantly higher for patients undergoing late operations (5.2% vs 3.5%, p = 0.046) despite similar preoperative risk (STS PROM 3.8% vs 3.3%) and major complication rates (18.2% vs 18.3%). Costs were 8% higher with late start cases ($51,576 vs $47,641, p < 0.001). After controlling for case type, surgeon, year, and risk, late cases resulted in higher mortality (odds ratio 2.04, p = 0.041) despite shorter operative duration (16 minutes, p < 0.001).Starting non-emergent cardiac cases later in the day is associated with 2 times higher absolute and risk-adjusted mortality. These data should be carefully considered, not only by surgeons and patients but also in the context of the operating room system when scheduling non-emergent cardiac cases.

SUBMITTER: Yount KW

PROVIDER: S-EPMC4630095 | biostudies-literature | 2015 Nov

REPOSITORIES: biostudies-literature

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Late Operating Room Start Times Impact Mortality and Cost for Nonemergent Cardiac Surgery.

Yount Kenan W KW Lau Christine L CL Yarboro Leora T LT Ghanta Ravi K RK Kron Irving L IL Kern John A JA Ailawadi Gorav G

The Annals of thoracic surgery 20150721 5

<h4>Background</h4>There is growing concern over the effect of starting non-emergent cardiac surgery later in the day on clinical outcomes and resource utilization. Our objective was to determine the differences in patient outcomes for starting non-emergent cardiac surgery after 3 pm.<h4>Methods</h4>All non-emergent cardiac operations performed at a single institution from July 2008 to 2013 were reviewed. Cases were stratified based on "early start" or "late start," defined by incision time befo ...[more]

PMID: 26209491

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Project description:BACKGROUND:Few diseases truly require emergency surgery today. We investigated the relationship between access to operating room (OR) and outcomes for patients with life-threatening emergency general surgery (LT-EGS) diseases at US hospitals. METHODS:In 2015, we surveyed 2,811 US hospitals on EGS practices, including how OR access is assured (e.g., OR staffing, block time). There were 1,690 (60%) hospitals that responded. We anonymously linked survey data to 2015 Statewide Inpatient Sample data (17 states) using American Hospital Association identifiers. Adults admitted with life-threatening diagnoses (e.g., necrotizing fasciitis, perforated viscus) who underwent operative intervention the same calendar day as hospital admission were included. Primary outcome was in-hospital mortality. Univariate and multivariable regression analyses, clustered by treating hospital and adjusted for patient factors, were performed to examine hospital-level OR access variables. RESULTS:Overall, 3,620 patients were admitted with LT-EGS diseases. The median age was 63 years (interquartile range, 51-75), with half having three or more comorbidities (50%). Thirty-four percent had one or more major systemic complication, and 5% died. The majority got care at hospitals with less than 1 day of EGS block time but with policies to ensure emergency access to the OR. After adjusting for age, sex, race, insurance status, comorbidities, systemic complications, and surgical complications, we found that less presence of an in-house EGS surgeon, compared with around the clock, was associated with increased mortality (rarely/never in-house surgeon: odds ratio, 2.4; 95% confidence interval [CI],1.1-5.3; sometimes in-house surgeon: odds ratio, 1.6; 95% CI, 1.1-2.3). In addition, after controlling for other factors, on-call overnight recovery room nurse, compared with in-house, was associated with an increased mortality (odds ratio, 2.2; 95% CI, 1.5-3.1). CONCLUSION:Round-the-clock availability of personnel, specifically emergency general surgeons and recovery room nurses, is associated with decreased mortality. These findings have implications for the creation of EGS patient triage criteria and Acute Care Surgery Centers of Excellence. LEVEL OF EVIDENCE:Therapeutic, level III.

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Late Operating Room Start Times Impact Mortality and Cost for Nonemergent Cardiac Surgery.

Publications

Late Operating Room Start Times Impact Mortality and Cost for Nonemergent Cardiac Surgery.

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