Consecutive Surgeon and Anesthesia Team Improve Turnover Time in the Operating Room.

Efficient management of the operating room (OR) contributes to much of today's healthcare expenditure and plays a critical role in generating revenue for most healthcare systems. Scheduling of OR cases with the same team and surgeon have been reported to improve turnover time between cases which in turn, improves efficiency and resource utilization. We aim to assess different operating room procedures within multiple subspecialties and explore the factors that positively and negatively influence turnover time (TOT) in the operating room. We conducted a retrospective review of cases that were completed on weekdays between 0600 and 2359 from July 2017 through March 2018. Cases between 0000 and 0559 were excluded from this study. Of the total 2,714 cases included in our study, transplant surgery had the highest mean TOT (71 ± 48 min) with orthopedic surgery cases without robots having the lowest mean TOT. OR cases in rooms with the same specialty had significantly less mean TOT compared to rooms switching between different subspecialties (70 vs. 117 min; p < 0.0001). Similarly, cases with the same surgeon and anesthesia team had a significant lower TOT (p < 0.0001). Consecutive specialty, surgeon, anesthesiologist, and prior procedure ending before 15:00 were all independent predictors of lower TOT (p < 0.0001). Our study shows scheduling cases with the same OR team for elective cases can decrease TOT and potentially increase operating room efficiency during the day. Further studies may be needed to assess the long-term effects of such variables affecting OR TOT on healthcare expenditure.

Impact of Operating Room Environment on Postoperative Central Nervous System Infection in a Resource-Limited Neurosurgical Center in South Asia.

BACKGROUND: Postoperative central nervous system infections (PCNSIs) are serious complications following neurosurgical intervention. We previously investigated the incidence and causative pathogens of PCNSIs at a resource-limited, neurosurgical center in south Asia. This follow-up study was conducted to analyze differences in PCNSIs at the same institution following only one apparent change: the operating room air filtration system. METHODS: This was a retrospective study of all neurosurgical cases performed between December 1, 2013, and March 31, 2016 at our center. Providers, patient demographic data, case types, perioperative care, rate of PCNSI, and rates of other complications were reviewed. These results were then compared with the findings of our previous study of neurosurgical cases between June 1, 2012, and June 30, 2013. RESULTS: All 623 neurosurgical operative cases over the study period were reviewed. Four patients (0.6%) had a PCNSI, and no patients had a positive cerebrospinal fluid (CSF) culture. In the previous study, among 363 cases, 71 patients (19.6%) had a PCNSI and 7 (1.9%) had a positive CSF culture (all Gram-negative organisms). The differences in both parameters are statistically significant (P < 0.001). Between the 2 studies, there was no change in treatment providers, case types, case durations, antibiotic administration practices, and patient demographics. CONCLUSIONS: The rates of PCNSI and positive CSF culture were significantly lower in our present cohort compared with the cohort in our previous study. The sole apparent change involves the air filtration system inside the neurosurgical operating rooms; this environmental change occurred during the 5 months between the 2 studies. This study demonstrates the impact of environmental factors in reducing infections.