Specialty acuity should be a consideration while assessing operating room block time metrics

Objective

Operating room (OR) utilization is a key metric of productivity for surgeons and surgical services. It is defined as total hours of elective surgery performed within OR block time, including turnover time, divided by the hours of allocated block time. To maximize this metric, hospitals have OR release times built in, which often trigger 72 hours prior to the start of the day. Vascular surgery is among several disciplines that carry a high number of urgent case bookings that require last minute OR availability. The purpose of this study was to examine OR release policy within our own institution in the context of the number of cases booked after the release period by vascular surgery and other surgical services.

Methods

A single-center retrospective review of all cases done by the Department of Surgery between October 2021 and October 2022 at a tertiary care university hospital was performed. Urgent cases were defined as those booked within 48 hours of the procedure. Total cases, inpatient vs outpatient/preadmit designation, number of urgent cases booked, OR utilization, and surgeon division were collated. included divisions were vascular (5 surgeons), colorectal (3 surgeons), bariatrics (2 surgeons), breast (7 surgeons), acute care (10 surgeons), general (8 surgeons), plastics (8 surgeons), otolaryngology (5 surgeons), and urology (6 surgeons). Additionally, we propose a novel method to calculate OR utilization based on the number of urgent cases performed by each specialty.

Results

A total of 9295 surgeries were performed by 54 surgeons. Of the surgeries, 1849 were performed on inpatients. Vascular surgeons accounted for 9% of surgeons in the study and booked 372 urgent cases (26%), representing the highest of all divisions including acute care surgery, who booked 180 urgent cases (13%). In addition, vascular surgery performed 26% (n = 476) of all inpatient surgeries during the study period, which made up over one-half (55%) of the total vascular volume of 865 cases. This was the highest percentage of inpatients throughout the surgical service line. Despite this, vascular surgery had one of the lowest OR utilizations at 65% during this time period. However, after accounting for number of urgent cases using the proposed formula, vascular surgery's adjusted OR utilization was found to be 115.7%.

Conclusions

Ensuring OR availability for services that have high urgency and substantial inpatient volume may allow greater system throughput, patient satisfaction, decreased length of stay, and lower surgeon stress burden. Vascular surgeons had the highest urgent and inpatient case volume of all examined surgical specialties. Hybrid OR availability and allocation of block time for vascular services should be reflected in the need to accommodate this operative climate.