Purpose
Operating room (OR) efficiency has an impact on surgeon productivity and patient experience.
Accuracy of case duration estimation is important to optimize OR efficiency. The purpose
of this study was to identify factors associated with inaccurate case time estimates
in outpatient hand surgery. A better understanding of these findings may help to improve
OR efficiency and scheduling.
Methods
All outpatient hand surgical cases from 2018 to 2019 were reviewed. Poorly-estimated
cases (i.e., poor scheduling accuracy) were defined as those cases where the actual
operative time differed from the predicted time by >50% (either quicker by >50% or
slower by >50% than the predicted time). The percentages of poorly-estimated cases
were analyzed, categorized, and compared by surgeon, procedure type, and scheduled
case length.
Results
A total of 6,620 cases were identified. Of 1,107 (16.7%) cases with poorly estimated
case durations, 75.2% were underestimated. There was no difference in the likelihood
of poor estimation related to start time. Well-estimated cases tended to have longer
scheduled case duration, but shorter realized case duration and surgical time. Our
systems analysis identified specific surgeons and procedures as predictable outliers.
Cases scheduled for 15–30 minutes frequently were inaccurate, whereas cases scheduled
for 30–45 and 106–120 minutes had accurate estimates.
Conclusions
The accuracy of case time estimations in a standard outpatient hand surgery practice
is highly variable. Nearly one-fifth of outpatient hand surgery case durations are
poorly estimated, and inaccurate case time estimation can be predicted based on surgeon,
procedure type, and case time.
Clinical Relevance
Maximizing OR efficiency should be a priority for surgeons and hospital systems. With
multiple surgeries done per day, the efficiency of the OR has an impact on surgeon
productivity and patient experience.
Key words
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References
- An analysis of surgical and nonsurgical operating room times in high-volume shoulder arthroplasty.J Shoulder Elbow Surg. 2017; 26: 1058-1063
- Factors affecting hand surgeon operating room turnover time.Hand. 2016; 11: 489-494
- The efficiency of a dedicated staff on operating room turnover time in hand surgery.J Hand Surg Am. 2014; 39: 108-110
- Preparatory Time–related hand surgery operating room inefficiency: a systems analysis.Hand. 2019; 15: 659-665
- The effect of an orthopedic specialty hospital on operating room efficiency in shoulder arthroplasty.J Shoulder Elbow Surg. 2019; 28: 15-21
- Dedicated orthopedic operating room unit improves operating room efficiency.J Arthroplasty. 2013; 28: 1066-1071. e2
- The addition of a regional block team to the orthopedic operating rooms does not improve anesthesia-controlled times and turnover time in the setting of long turnover times.J Clin Anesthesiol. 2007; 19: 85-91
- Anesthesia-controlled time and turnover time for ambulatory upper extremity surgery performed with regional versus general anesthesia.J Clin Anesth. 2009; 21: 253-257
- The impact of overestimations of surgical control times across multiple specialties on medical systems.J Med Syst. 2016; 40: 95
- The influence of anesthesia-controlled time on operating room scheduling in Dutch university medical centres.Canad J Anesthes. 2014; 61: 524-532
- Improving the prediction of total surgical procedure time using linear regression modeling.Frontiers Med. 2017; 4: 85
- Scheduling anesthesia time reduces case cancellations and improves operating room workflow in a university hospital setting.J Am Coll Surg. 2016; 223: 343-351
- How to schedule elective surgical cases into specific operating rooms to maximize the efficiency of use of operating room time.Anesth Analg. 2002; 94: 933-942
- Systematic review of general thoracic surgery articles to identify predictors of operating room case durations.Anesth Analg. 2008; 106: 1232-1241
- Improving operating room efficiency: machine learning approach to predict case-time duration.J Am Coll Surg. 2019; 229: 346-354.e3
- Machine learning can improve estimation of surgical case duration: a pilot study.J Med Syst. 2019; 43: 44
- Value of a scheduled duration quantified in terms of equivalent numbers of historical cases.Anesth Analg. 2013; 117: 205-210
- Use of historical surgical times to predict duration of primary total knee arthroplasty.J Arthroplasty. 2016; 31: 2768-2772
- Improving prediction of surgery duration using operational and temporal factors.AMIA Annu Symp Proc. 2012; 2012: 456-462
- Surgeon and type of anesthesia predict variability in surgical procedure times.Anesthesiology. 2000; 92: 1454-1466
- Accuracy of predicting the duration of a surgical operation.J Oral Maxillofac Surg. 2013; 71: 446-447
- Prospective trial of thoracic and spine surgeons' updating of their estimated case durations at the start of cases.Anesth Analg. 2010; 110: 1164-1168
- Surgical duration estimation via data mining and predictive modeling: a case study.AMIA Annu Symp Procedure. 2015; 2015: 640-648
- “Improvement of surgery duration estimation using statistical methods and analysis of scheduling policies using discrete event simulation”.Graduate Theses and Dissertations, 2015 (14497)
- Statistical Method from the Viewpoint of Quality Control.Dover Publications, Washington1945
- Quality, Productivity and Competitive Position.MIT Press, Cambridge1982
Article info
Publication history
Published online: November 03, 2022
Accepted:
August 31,
2022
Received:
February 7,
2022
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.