A regional anesthesia-based “swing” operating room model reduces non-operative time in a mixed orthopedic inpatient/outpatient population

Abstract

A regional anesthesia-based ''swing'' operating room model reduces non-operative time in a mixed orthopedic inpatient/ outpatient population Un modèle de salle « en rotation » basée sur l'anesthésie régionale en orthopédie réduit le temps non-opératoire dans une population mixte de patients ambulatoires et hospitalisés Abstract Purpose We recently reported on the efficacy of a new ''swing'' room model involving two alternating ORs and regional anesthesia in increasing operating room (OR) throughput in a dedicated ambulatory orthopedic surgery facility. The purpose of this study was to evaluate this model in a main OR suite setting with typical mixed inpatient/outpatient cases. Methods We conducted a retrospective matched-pair cohort study of 133 upper extremity surgery patients treated in the swing room model under ultrasound-guided brachial plexus blockade. We compared this cohort with case-matched historical controls treated in the traditional single OR model under general anesthesia. The primary endpoint was non-operative time, defined as the interval between skin closure and incision in the following case.Secondary endpoints included throughput estimated as the median number of cases per eight-hour day, postanesthesia care unit (PACU) bypass rates, and postoperative pain/ nausea and vomiting (PONV) intervention rates. Results Compared with the control group, non-operative times in the swing room group were faster (swing: median 19 min; interquartile range [IQR 8-31] vs control: median 57 min; IQR [49-65]; P \ 0.0001). In the swing room model, the estimated daily throughput was 33% greater (swing: median 5.6 cases; IQR [5.0-6.2] vs control: median 4.2 cases; IQR [4.0-4.4]; P \ 0.0001), and the PACU bypass rate was higher (swing: 60% vs control: 0%; P \ 0.0001). Fewer patients received postoperative opioids (swing: 20% vs control: 82%; P \ 0.0001) and treatment for PONV (swing: 2% vs control: 20%; P \ 0.0001) in the swing room model. Conclusion The implementation of a ''swing'' room care model based on ultrasound-guided regional anesthesia in a typical mixed inpatient/outpatient population decreased non-operative times, increased throughput, and improved recovery profiles compared with case-matched historical controls in the traditional model under general anesthesia. RésuméObjectif Nous avons re´cemment parle´de l'efficaciteṕ our l'augmentation du nombre de cas traite´s d'un nouveau mode`le de salle « en rotation » impliquant l'utilisation en alternance de deux salles d'ope´ration et l'utilisation de l'anesthe´sie re´gionale dans un centre spe´cialise´en chirurgie orthope´dique ambulatoire. L'objectif de cette e´tude e´tait d'e´valuer ce mode`le dans le cadre d'un ensemble de salles d'ope´rations accueillant aussi bien des patients hospitalise´s que des patients ambulatoires.

Hemidiaphragmatic Paralysis Following Ultrasound-Guided Supraclavicular Versus Infraclavicular Brachial Plexus Blockade

“…One patient in the infraclavicular group was inadvertently enrolled and randomized at an age of 61 years on the day of surgery; the patient's data were analyzed as allocated. Both groups were similar in terms of patient demographic data, location of surgery (our center's regional anesthesia-based outpatient department surgical procedure rooms 21 vs main operating room suite 22 ), and types of surgery ( Table 1). As well, both groups were comparable in terms of basic block data, including sedation received, scan times, and needle times ( Table 2).…”

Improving operating room productivity via parallel anesthesia processing

“…Upper extremity surgical procedures are commonly performed under regional anesthesia, which has advantages over general anesthesia including superior postoperative analgesia, reduced side-effects associated with general anesthesia and reduced post anesthesia care unit admission rates (Head et al, 2011;Mercereau et al, 2012). However, regional anesthesia administered in the OR is associated with longer non-operative anesthesia preparatory time when compared to general anesthesia (Armstrong and Cherry, 2004).…”

“…The drivers for these performance improvements with parallel processing are the improved time distribution between OR entry and incision and room turnover times associated with parallel processing. Regional anesthesia advantages include avoiding general anesthesia and its associated side-effects such as nausea and vomiting, reduced need for admission to post anesthesia care and improved short-term postoperative analgesia (Head et al, 2011;Mercereau et al, 2012). Importantly, however, regional anesthesia can be associated with increased resource utilization, personnel and set up time when compared to general anesthesia (Armstrong and Cherry, 2004).…”

Regional Versus General Anesthesia and the Incidence of Unplanned Health Care Resource Utilization for Postoperative Pain After Wrist Fracture Surgery

“…For surgery on the upper extremity performed under brachial plexus blockade, for example, these include improved immediate/in-hospital postoperative pain management, a marked reduction in postoperative nausea and vomiting, shorter/eliminated postanesthesia care unit stay requirements, and a decrease in nonoperative times. [2][3][4][5][6][7][8][9] Our institution, a tertiary/quaternary care academic health sciences center in Vancouver, British Columbia, Canada (St. Paul's Hospital), established and implemented a dedicated ultrasoundguided regional anesthesia service in 2008-2009. In part because of the documented outcome benefits over the historical GA-based care, 8,9 this has resulted in a marked increase in PNBs for orthopedic extremity surgery, including single-shot brachial plexus blocks (sBPBs) for ambulatory wrist fracture surgery, a common and painful procedure.…”

“…[2][3][4][5][6][7][8][9] Our institution, a tertiary/quaternary care academic health sciences center in Vancouver, British Columbia, Canada (St. Paul's Hospital), established and implemented a dedicated ultrasoundguided regional anesthesia service in 2008-2009. In part because of the documented outcome benefits over the historical GA-based care, 8,9 this has resulted in a marked increase in PNBs for orthopedic extremity surgery, including single-shot brachial plexus blocks (sBPBs) for ambulatory wrist fracture surgery, a common and painful procedure. 10,11 As sBPBs rapidly became the preferred anesthetic technique for these procedures, we received anecdotal reports from our orthopedic surgeons about a perceived increase in unplanned postoperative emergency department (ED) or physician office visits for pain after block resolution among ambulatory patients who underwent sBPB.…”