Starting late does not increase the risk of post-operative complications in patients undergoing common general surgical procedures.
Delayed operation
First case delay
Late start
Operating room efficiency
Tardy start
Time of surgery
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
06 2022
06 2022
Historique:
received:
01
04
2021
accepted:
24
08
2021
pubmed:
3
9
2021
medline:
14
5
2022
entrez:
2
9
2021
Statut:
ppublish
Résumé
There is a paucity of evidence surrounding the issue of delays on the day of surgery with respect to both causes and consequences. We sought to determine whether patients whose operations started late were at increased risk of post-operative complications. We conducted a retrospective cohort study of 1420 first-of-the-day common general surgical procedures, dividing these into "on-time start" (OTS) and "late-start" (LS) cases. Our primary outcomes were minor and major complication rate; our secondary objective was to identify factors predicting LS. Groups were compared using univariable and multivariable analysis. LS rate was 55.3%. On univariable analysis, LS had higher rates of major and minor complications (7.3% vs. 3.5%, p = 0.002; 3.8% vs. 1.6%, p = 0.011). On multivariable analysis, LS was not associated with increased odds of any complications. Minor complications were predicted by operative duration [OR = 1.005 (1.002-1.008)], female sex [OR = 1.78 (1.037-3.061)], and undergoing an ileostomy closure procedure [OR = 10.60 (2.791-40.246)], and were reduced in those undergoing surgery on Wednesdays [OR = 0.38 (0.166-0.876)]. Major complications were predicted by operative duration [OR = 1.007 (1.003-1.011)] and ASA class [OR = 6.73 (1.505-30.109)]. Multivariable analysis using LS as an outcome identified that anesthesia time [OR = 1.35 (1.031-1.403)], insulin-dependent diabetes [OR = 1.91 (1.128-3.246)], and dyspnea upon moderate exertion [OR = 2.52 (1.423-4.522)] were predictive of LS. Most cases in our study started late. While this has significant efficiency and economic costs, it is not associated with adverse patient outcomes. This topic remains incompletely described. Further research is needed to improve efficiency and patient experience by investigating the causes of operative delays.
Sections du résumé
BACKGROUND
There is a paucity of evidence surrounding the issue of delays on the day of surgery with respect to both causes and consequences. We sought to determine whether patients whose operations started late were at increased risk of post-operative complications.
METHODS
We conducted a retrospective cohort study of 1420 first-of-the-day common general surgical procedures, dividing these into "on-time start" (OTS) and "late-start" (LS) cases. Our primary outcomes were minor and major complication rate; our secondary objective was to identify factors predicting LS. Groups were compared using univariable and multivariable analysis.
RESULTS
LS rate was 55.3%. On univariable analysis, LS had higher rates of major and minor complications (7.3% vs. 3.5%, p = 0.002; 3.8% vs. 1.6%, p = 0.011). On multivariable analysis, LS was not associated with increased odds of any complications. Minor complications were predicted by operative duration [OR = 1.005 (1.002-1.008)], female sex [OR = 1.78 (1.037-3.061)], and undergoing an ileostomy closure procedure [OR = 10.60 (2.791-40.246)], and were reduced in those undergoing surgery on Wednesdays [OR = 0.38 (0.166-0.876)]. Major complications were predicted by operative duration [OR = 1.007 (1.003-1.011)] and ASA class [OR = 6.73 (1.505-30.109)]. Multivariable analysis using LS as an outcome identified that anesthesia time [OR = 1.35 (1.031-1.403)], insulin-dependent diabetes [OR = 1.91 (1.128-3.246)], and dyspnea upon moderate exertion [OR = 2.52 (1.423-4.522)] were predictive of LS.
CONCLUSIONS
Most cases in our study started late. While this has significant efficiency and economic costs, it is not associated with adverse patient outcomes. This topic remains incompletely described. Further research is needed to improve efficiency and patient experience by investigating the causes of operative delays.
Identifiants
pubmed: 34471981
doi: 10.1007/s00464-021-08694-6
pii: 10.1007/s00464-021-08694-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3781-3788Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
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