Patient Factors and Their Effect on Operating Room Time for Urologic Procedures
Abstract
:1. Introduction
2. Methods
2.1. Participation Identification and Data Collection
2.2. Statistical Analysis
3. Results
3.1. Ureteroscopy
3.2. Transurethral Resection of the Prostate
3.3. Transurethral Resection of Bladder Tumors
3.4. Prostatectomy (Robotic-Assisted)
3.5. Nephrectomy
3.6. Kidney Transplant
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Childers, C.P.; Maggard-Gibbons, M. Understanding Costs of Care in the Operating Room. JAMA Surg. 2018, 153, 4. [Google Scholar] [CrossRef]
- Li, L.X.; Benton, W.C.; Leong, G.K. The impact of strategic operations management decisions on community hospital performance. J. Oper. Manag. 2002, 20, 389. [Google Scholar] [CrossRef]
- Macario, A.; Vitez, T.S.; Dunn, B.; McDonald, T. Where are the costs in perioperative care? Analysis of hospital costs and charges for inpatient surgical care. Anesthesiology 1995, 83, 1138. [Google Scholar] [CrossRef]
- Mantha, S.; Roizen, M.F.; Madduri, J.; Rajender, Y.; Naidu, K.S.; Gayatri, K. Usefulness of routine preoperative testing: A prospective single-observer study. J. Clin. Anesth. 2005, 17, 51. [Google Scholar] [CrossRef]
- Hales, C.M.; Carroll, M.D.; Fryar, C.D.; Ogden, C.L. Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018. NCHS Data Brief 2020, 360, 1–8. [Google Scholar]
- Ward, Z.J.; Bleich, S.N.; Cradock, A.L.; Barrett, J.L.; Giles, C.M.; Flax, C.; Long, M.W.; Gortmaker, S.L. Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity. N. Engl. J. Med. 2019, 381, 2440–2450. [Google Scholar] [CrossRef]
- Blüher, M. Obesity: Global epidemiology and pathogenesis. Nat. Rev. Endocrinol. 2019, 15, 288–298. [Google Scholar] [CrossRef]
- Raphael, I.J.; Parmar, M.; Mehrganpour, N.; Sharkey, P.F.; Parvizi, J. Obesity and operative time in primary total joint arthroplasty. J. Knee Surg. 2013, 26, 95–99. [Google Scholar] [CrossRef]
- Horvath, B.; Kloesel, B.; Todd, M.M.; Cole, D.J.; Prielipp, R.C. The Evolution, Current Value, and Future of the American Society of Anesthesiologists Physical Status Classification System. Anesthesiology 2021, 135, 904–919. [Google Scholar] [CrossRef]
- Kraev, A.I.; McGinn, J.; Etkin, Y.; Turner, J.W.; Landis, G.S. Improving the Power of the American Society of Anesthesiology Classification System to Risk Stratify Vascular Surgery Patients Based on National Surgical Quality Improvement Project-Defined Functional Status. Ann. Vasc. Surg. 2018, 52, 153–157. [Google Scholar] [CrossRef]
- Markovic, D.Z.; Jevtovic-Stoimenov, T.; Stojanovic, M.; Vukovic, A.Z.; Dinic, V.; Markovic-Zivkovic, B.Z.; Jankovic, R.J. Cardiac biomarkers improve prediction performance of the combination of American Society of Anesthesiologists physical status classification and Americal College of Surgeons National Surgical Quality Improvement Program calculator for postoperative mortality in elderly patients: A pilot study. Aging Clin. Exp. Res. 2019, 31, 1207–1217. [Google Scholar]
- Peters, R.M.; van Steenbergen, L.N.; Stewart, R.E.; Stevens, M.; Rijk, P.C.; Bulstra, S.K.; Zijlstra, W.P. Patient Characteristics Influence Revision Rate of Total Hip Arthroplasty: American Society of Anesthesiologists Score and Body Mass Index Were the Strongest Predictors for Short-Term Revision After Primary Total Hip Arthroplasty. J. Arthroplast. 2020, 35, 188–192.e2. [Google Scholar] [CrossRef]
- Tariq, H.; Ahmed, R.; Kulkarni, S.; Hanif, S.; Toolsie, O.; Abbas, H.; Chilimuri, S. Development, Functioning, and Effectiveness of a Preoperative Risk Assessment Clinic. Health Serv. Insights 2016, 9 (Suppl. 1), 1–7. [Google Scholar] [CrossRef]
- Ferschl, M.B.; Tung, A.; Sweitzer, B.; Huo, D.; Glick, D.B. Preoperative clinic visits reduce operating room cancellations and delays. Anesthesiology 2005, 103, 855–859. [Google Scholar] [CrossRef]
- Strumpf, E. The obesity epidemic in the United States: Causes and extent, risks and solutions. Issue Brief (Commonw. Fund) 2004, 713, 1–6. [Google Scholar]
- Lenardis, M.; Harper, B.; Satkunasivam, R.; Klaassen, Z.; Wallis, C.J.D. The association between patient body mass index and perioperative outcomes following radical cystectomy: An analysis using the American College of Surgeons National Surgical Quality Improvement Program database. Can. Urol. Assoc. 2020, 14, E412–E417. [Google Scholar] [CrossRef]
- Julien, J.B.S.; Aldrich, M.C.; Sheng, S.; Deppen, S.A.; Burfeind, W.R., Jr.; Putnam, J.B.; Lambright, E.S.; Nesbitt, J.C.; Grogan, E.L. Obesity increases operating room time for lobectomy in the society of thoracic surgeons database. Ann. Thorac. Surg. 2012, 94, 1841. [Google Scholar] [CrossRef]
- Villavicencio, A.; Lee Nelson, E.; Rajpal, S.; Vivek, N.; Burneikiene, S. The impact of BMI on operating room time, blood loss, and hospital stay in patients undergoing spinal fusion. Clin. Neurol. Neurosurg. 2019, 179, 19–22. [Google Scholar] [CrossRef]
- Gottschalk, M.B.; Hinds, R.M.; Muppavarapu, R.C.; Brock, K.; Sapienza, A.; Paksima, N.; Capo, J.T.; Yang, S.S. Factors Affecting Hand Surgeon Operating Room Turnover Time. Hand 2016, 11, 489–494. [Google Scholar] [CrossRef]
- Marjamaa, R.; Vakkuri, A.; Kirvelä, O. Operating room management: Why, how and by whom? Acta Anaesthesiol. Scand. 2008, 52, 596–600. [Google Scholar] [CrossRef]
- Emanuel, A.; Macpherseon, R. The anaesthetic pre-admission clinic is effective in minimising surgical cancellation rates. Anaesth. Intensive Care 2013, 41, 90–94. [Google Scholar] [CrossRef]
- Wu, C.; Evans, I.; Joseph, R.; Shapiro, R.; Tan, H.; Basu, A.; Smetanka, C.; Khan, A.; McCauley, J.; Unruh, M. Comorbid conditions in kidney transplantation: Association with graft and patient survival. J. Am. Soc. Nephrol. 2005, 16, 3437–3444. [Google Scholar] [CrossRef]
No. Cases | Median (min) | Longest OR Time (min) | Shortest OR Time (min) | IQR | |
---|---|---|---|---|---|
Ureteroscopy | 316 | 93.5 | 420 | 35 | 54.7 |
TURP | 146 | 104 | 299 | 51 | 57.5 |
TURBT | 182 | 82.0 | 261 | 28 | 51.0 |
Prostatectomy | 150 | 326 | 880 | 167 | 223 |
Nephrectomy | 226 | 300 | 833 | 58 | 131 |
Kidney Transplant | 428 | 303 | 766 | 169 | 113 |
No. Cases | Beta | Coefficient Std. Error | Time Difference (%) | Lower Bound (%) | Upper Bound (%) | p-Value | |
---|---|---|---|---|---|---|---|
PAT | |||||||
No (ref.) | |||||||
Yes | 116 | 0.059 | 0.048 | 6.07 | −3.67 | 16.6 | 0.222 |
BMI | |||||||
Healthy (ref.) | |||||||
Underweight | 6 | −0.397 | 0.175 | −48.7 | −110 | −5.33 | 0.024 |
Overweight | 78 | −0.052 | 0.075 | −5.33 | −22.0 | 10.0 | 0.488 |
Class I | 71 | 0.015 | 0.076 | 1.51 | −14.3 | 17.8 | 0.846 |
Class II | 59 | −0.075 | 0.079 | −7.79 | −26.1 | 8.44 | 0.344 |
Class III | 52 | 0.157 | 0.083 | 17.0 | −0.60 | 37.7 | 0.059 |
ASA Status | |||||||
ASA I (ref.) | |||||||
ASA II | 133 | 0.039 | 0.112 | 3.98 | −19.8 | 29.4 | 0.729 |
ASA III | 161 | 0.056 | 0.112 | 5.76 | −17.8 | 31.9 | 0.617 |
ASA IV | 11 | 0.148 | 0.167 | 16.0 | −20.0 | 61.1 | 0.378 |
No. Cases | Beta | Coefficient Std. Error | Time Difference (%) | Lower Bound (%) | Upper Bound (%) | p-Value | |
---|---|---|---|---|---|---|---|
PAT | |||||||
No (ref.) | |||||||
Yes | 76 | −0.062 | 0.059 | −6.39 | −19.5 | 5.55 | 0.296 |
BMI | |||||||
Healthy (ref.) | |||||||
Overweight | |||||||
Class I | 39 | −0.110 | 0.086 | −11.6 | −32.2 | 6.18 | 0.204 |
Class II | 14 | −0.182 | 0.110 | −20.0 | −49.0 | 3.46 | 0.098 |
Class III | 5 | 0.123 | 0.163 | 13.1 | −22.1 | 56.2 | 0.453 |
ASA Status | |||||||
ASA I (ref.) | |||||||
ASA II | 46 | 0.238 | 0.202 | 26.9 | −17.6 | 89.1 | 0.241 |
ASA III | 90 | 0.250 | 0.201 | 28.4 | −15.8 | 91.2 | 0.215 |
ASA IV | 7 | −0.018 | 0.233 | −1.82 | −61.4 | 55.7 | 0.939 |
No. Cases | Beta | Coefficient Std. Error | Time Difference (%) | Lower Bound (%) | Upper Bound (%) | p-Value | |
---|---|---|---|---|---|---|---|
PAT | |||||||
No (ref.) | |||||||
Yes | 82 | −0.158 | 0.059 | −17.1 | −31.6 | −4.02 | 0.009 |
BMI | |||||||
Healthy (ref.) | |||||||
Underweight | 6 | −0.010 | 0.164 | −1.01 | −39.5 | 36.8 | 0.951 |
Overweight | 64 | −0.052 | 0.079 | −5.33 | −23.1 | 11.1 | 0.517 |
Class I | 38 | 0.134 | 0.090 | 14.3 | −4.39 | 36.5 | 0.138 |
Class II | 22 | 0.106 | 0.106 | 11.1 | −11.0 | 37.2 | 0.320 |
Class III | 11 | −0.023 | 0.137 | −2.33 | −34.2 | 28.3 | 0.869 |
ASA Status | |||||||
ASA II (ref.) | |||||||
ASA III | 138 | −0.038 | 0.080 | −3.87 | −21.7 | 12.6 | 0.632 |
ASA IV | 13 | 0.191 | 0.133 | 21.0 | −7.36 | 57.5 | 0.152 |
No. Cases | Beta | Coefficient Std. Error | Time Difference (%) | Lower Bound (%) | Upper Bound (%) | p-Value | |
---|---|---|---|---|---|---|---|
PAT | |||||||
No (ref.) | |||||||
Yes | 106 | −0.132 | 0.068 | −16.4 | −30.5 | 0.20 | 0.053 |
BMI | |||||||
Healthy (ref.) | |||||||
Underweight | 1 | −0.130 | 0.374 | −2.74 | −138 | 84.0 | 0.729 |
Overweight | 64 | 0.048 | 0.084 | 6.18 | −12.5 | 23.7 | 0.569 |
Class I | 37 | 0.293 | 0.093 | 37.7 | 11.4 | 61.1 | 0.002 |
Class II | 18 | 0.271 | 0.114 | 24.6 | 4.71 | 64.2 | 0.019 |
Class III | 2 | 0.655 | 0.269 | 21.3 | 13.0 | 228 | 0.016 |
ASA Status | |||||||
ASA I (ref.) | |||||||
ASA II | 59 | 0.145 | 0.147 | 19.8 | −15.6 | 54.7 | 0.324 |
ASA III | 81 | 0.278 | 0.146 | 42.3 | −1.01 | 76.1 | 0.059 |
ASA IV | 3 | −0.372 | 0.295 | 11.6 | −23.5 | 160 | 0.209 |
No. Cases | Beta | Coefficient Std. Error | Time Difference (%) | Lower Bound (%) | Upper Bound (%) | p-Value | |
---|---|---|---|---|---|---|---|
PAT | |||||||
No (ref.) | |||||||
Yes | 137 | 0.005 | 0.055 | 0.501 | −11.0 | 12.1 | 0.924 |
BMI | |||||||
Healthy (ref.) | |||||||
Underweight | 3 | −0.161 | 0.226 | −17.5 | −83.3 | 32.8 | 0.476 |
Overweight | 60 | 0.069 | 0.071 | 7.14 | −7.47 | 23.2 | 0.336 |
Class I | 62 | 0.117 | 0.073 | 12.4 | −2.63 | 29.8 | 0.109 |
Class II | 26 | 0.038 | 0.094 | 3.87 | −15.7 | 25.0 | 0.683 |
Class III | 17 | 0.082 | 0.109 | 8.55 | −14.22 | 34.6 | 0.453 |
ASA Status | |||||||
ASA I (ref.) | |||||||
ASA II | 69 | −0.036 | 0.079 | −3.67 | −21.0 | 12.6 | 0.645 |
ASA III | 101 | 0.064 | 0.077 | 6.61 | −9.20 | 24.0 | 0.407 |
ASA IV | 15 | 0.073 | 0.122 | 7.57 | −18.1 | 36.8 | 0.547 |
No. Cases | Beta | Coefficient Std. Error | Time Difference (%) | Lower Bound (%) | Upper Bound (%) | p-Value | |
---|---|---|---|---|---|---|---|
PAT | |||||||
No (ref.) | |||||||
Yes | 10 | 0.198 | 0.324 | 17.4 | −60.2 | 138 | 0.546 |
BMI | |||||||
Healthy (ref.) | |||||||
Underweight | 8 | 0.172 | 0.320 | 13.8 | −63.1 | 130 | 0.595 |
Overweight | 9 | 0.384 | 0.309 | 35.3 | −29.0 | 178 | 0.226 |
Class I | 1 | 0.852 | 0.721 | 29.7 | −89.3 | 941 | 0.249 |
Class II | 2 | −0.142 | 0.573 | −6.18 | −276 | 183 | 0.806 |
Class III | 18 | 0.058 | 0.354 | 5.02 | −96.2 | 120 | 0.872 |
ASA Status | |||||||
ASA I (ref.) | |||||||
ASA II | 8 | −0.069 | 0.413 | −5.34 | −152 | 119 | 0.868 |
ASA III | 10 | 0.198 | 0.324 | 17.4 | −60.2 | 138 | 0.546 |
ASA IV | 8 | 0.172 | 0.320 | 13.8 | −63.1 | 130 | 0.595 |
No. Cases | Beta | Coefficient Std. Error | Time Difference (%) | Lower Bound (%) | Upper Bound (%) | p-Value | |
---|---|---|---|---|---|---|---|
PAT | |||||||
No (ref.) | |||||||
Yes | 80 | 0.001 | 0.092 | 0.20 | −13.1 | 13.3 | 0.987 |
BMI | |||||||
Healthy (ref.) | |||||||
Overweight | 35 | −0.135 | 0.063 | −23.4 | −34.6 | 2.63 | 0.099 |
Class I | 29 | 0.016 | 0.081 | 2.43 | −16.8 | 20.7 | 0.849 |
Class II | 17 | −0.165 | 0.101 | −21.8 | −44.1 | 3.67 | 0.107 |
Class III | 11 | −0.051 | 0.117 | −5.23 | −32.7 | 19.8 | 0.664 |
ASA Status | |||||||
ASA I (ref.) | |||||||
ASA II | 40 | −0.022 | 0.082 | −3.56 | −20.3 | 15.0 | 0.788 |
ASA III | 48 | 0.018 | 0.085 | 3.05 | −16.3 | 20.6 | 0.831 |
ASA IV | 5 | 0.061 | 0.152 | 4.29 | −27.1 | 43.6 | 0.687 |
No. Cases | Beta | Coefficient Std. Error | Time Difference (%) | Lower Bound (%) | Upper Bound (%) | p-Value | |
---|---|---|---|---|---|---|---|
PAT | |||||||
No (ref.) | |||||||
Yes | 71 | −0.125 | 0.083 | −19.7 | −33.8 | 4.19 | 0.138 |
BMI | |||||||
Healthy (ref.) | |||||||
Overweight | 3 | −0.027 | 0.210 | −1.51 | −56.0 | 47.8 | 0.897 |
Class I | 28 | 0.170 | 0.109 | 22.8 | −4.81 | 47.4 | 0.122 |
Class II | 40 | 0.073 | 0.106 | 10.3 | −14.9 | 33.0 | 0.495 |
Class III | 12 | 0.082 | 0.142 | 7.47 | −22.3 | 43.9 | 0.566 |
ASA Status | |||||||
ASA I (ref.) | |||||||
ASA II | 6 | 0.028 | 0.201 | 1.82 | −45.4 | 53.7 | 0.890 |
ASA III | 35 | −0.098 | 0.116 | −14.1 | −38.8 | 14.1 | 0.400 |
ASA IV | 60 | 0.077 | 0.106 | 11.9 | −14.5 | 33.5 | 0.473 |
No. Cases | Beta | Coefficient Std. Error | Time Difference (%) | Lower Bound (%) | Upper Bound (%) | p-Value | |
---|---|---|---|---|---|---|---|
PAT | |||||||
No (ref.) | |||||||
Yes | 53 | 0.098 | 0.038 | 10.3 | 2.43 | 18.9 | 0.010 |
BMI | |||||||
Healthy (ref.) | |||||||
Underweight | 9 | −0.076 | 0.094 | −7.90 | −29.8 | 11.6 | 0.423 |
Overweight | 162 | 0.059 | 0.032 | 6.08 | 0.004 | 13.1 | 0.065 |
Class I | 123 | 0.090 | 0.034 | 9.42 | 2.33 | 17.0 | 0.008 |
Class II | 16 | 0.180 | 0.069 | 19.7 | 4.39 | 37.2 | 0.010 |
Class III | 4 | −0.059 | 0.131 | −6.08 | −37.2 | 22.0 | 0.651 |
ASA Status | |||||||
ASA II (ref.) | |||||||
ASA III | 43 | −0.173 | 0.129 | −18.9 | −53.1 | 8.44 | 0.182 |
ASA IV | 10 | −0.153 | 0.133 | −16.5 | −51.3 | 11.4 | 0.250 |
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Lu, W.-S.; Zia, A.; Nadiminty, N.; Saltzman, B.; Casabianca, A.B.; Sindhwani, P. Patient Factors and Their Effect on Operating Room Time for Urologic Procedures. Uro 2024, 4, 12-22. https://doi.org/10.3390/uro4010002
Lu W-S, Zia A, Nadiminty N, Saltzman B, Casabianca AB, Sindhwani P. Patient Factors and Their Effect on Operating Room Time for Urologic Procedures. Uro. 2024; 4(1):12-22. https://doi.org/10.3390/uro4010002
Chicago/Turabian StyleLu, Wei-Shin, Ali Zia, Nagalakshmi Nadiminty, Barbara Saltzman, Andrew B. Casabianca, and Puneet Sindhwani. 2024. "Patient Factors and Their Effect on Operating Room Time for Urologic Procedures" Uro 4, no. 1: 12-22. https://doi.org/10.3390/uro4010002