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Assessment of Operative Time for Lip and Oral Cancers: A Tool to Improve Operative Room Efficiency

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Abstract

Operation theatre (OT) time utilisation rates can be improved with an assessment of the procedure time that will result in effective scheduling of cases. Our study is the first of its kind to audit the amount of OT time required for a particular surgery in lip and oral cavity cancers, depending on the various components of this complex procedure. This prospective cross-sectional study, based on an operative room database of 323 OT sessions, was conducted in the Department of Surgical Oncology at a tertiary care centre on lip and oral cancer patients from January 1st, 2019 to December 31st, 2020. Various components of the surgery, like the primary site, operating surgeon, type of neck dissection, bone resection, and reconstructive procedure, were noted. The time of entry and exit of the patient from the OT was noted. Operative time and OT time utilisation rates were calculated. SPSS 21.0 statistical tool; Students ‘T’, ANOVA and Games-Howell tests were applied. In 323 OT sessions, while 303 surgeries were done for primary cases (93.8%), the remaining 20 cases were for recurrent cases (6.2%). Buccal mucosa and the floor of the mouth were the most and least common sites, respectively. The mean OT time was 212.42 ± 73.83 min, the maximum being the primary at alveolus. The mean OT late start time was 70.03 ± 23.41 min and the mean OT runover time was 37.62 ± 43.53 min. The mean time varied significantly with the type of neck dissection, bone resection, and reconstructive surgery done and the operating surgeon. The mean OT time was highest for free flap reconstructive surgery (328.71 ± 62.02 min), but it didn’t vary with its type. Considering only the lip and oral cancer surgeries, the OT time utilisation rate was 57.1%. Assessment and quantification of the operative duration of lip and oral cancer surgeries will help in accurate prediction of surgical duration, better OT list planning, and thus improved OT time utilisation rate. Our research not only provides data on the historical mean of procedures, but it may also encourage other centres to adopt our quantitative approach to OT scheduling.

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References

  1. Lewis MA, Hall RD, Okolo S, Yoong W (2012) How time flies: a prospective analysis of theatre efficiency during elective gynaecology lists. Gynecol Surg 9(2):213–217. https://doi.org/10.1007/s10397-011-0696-2

    Article  Google Scholar 

  2. Denton B, Viapiano J, Vogl A (2007) Optimization of surgery sequencing and scheduling decisions under uncertainty. Health Care Manag Sci 10:13–24. https://doi.org/10.1007/s10729-006-9005-4

    Article  PubMed  Google Scholar 

  3. O’Donnell DJ (1976) Theatre utilization analysis. Med J Aust 2:650–651. https://doi.org/10.5694/j.1326-5377.1976.tb98932.x

    Article  CAS  PubMed  Google Scholar 

  4. Divatia JV, Ranganathan P (2015) Can we improve operating room efficiency? J Postgrad Med 61(1):1–2. https://doi.org/10.4103/0022-3859.147000

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Donham RT, Mazzei WJ, Jones RL (1996) Procedural times glossary. Am J Anesthesiol 23(Suppl):4–12

    Google Scholar 

  6. Aupérin A (2020) Epidemiology of head and neck cancers: an update. Curr Opin Oncol 32(3):178–186. https://doi.org/10.1097/CCO.0000000000000629

    Article  PubMed  Google Scholar 

  7. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71(3):209–249. https://doi.org/10.3322/caac.21660

    Article  PubMed  Google Scholar 

  8. Gordon T, Paul S, Lyles A, Fountain J (1988) Surgical unit time utilization review: resource utilization and management implications. J Med Syst 12(3):169–179. https://doi.org/10.1007/BF00996639

    Article  CAS  PubMed  Google Scholar 

  9. Pandit JJ, Tavare A (2011) Using mean duration and variation of procedure times to plan a list of surgical operations to fit into the scheduled list time. Eur J Anaesthesiol 28(7):493–501. https://doi.org/10.1097/EJA.0b013e3283446b9c

    Article  PubMed  Google Scholar 

  10. Saha P, Pinjani A, Al-Shabibi N, Madari S, Ruston J, Magos A (2009) Why we are wasting time in the operating theatre? Int J Health Plann Manage 24:225–232. https://doi.org/10.1002/hpm.966

    Article  PubMed  Google Scholar 

  11. Delaney CL, Davis N, Tamblyn P (2010) Audit of the utilization of time in an orthopaedic trauma theatre. ANZ J Surg 80:217–222. https://doi.org/10.1111/j.1445-2197.2009.05043.x

    Article  PubMed  Google Scholar 

  12. Talati S, Gupta AK, Kumar A, Malhotra SK, Jain A (2015) An analysis of time utilization and cancellations of scheduled cases in the main operation theater complex of a tertiary care teaching institute of North India. J Postgrad Med 61(1):3–8. https://doi.org/10.4103/0022-3859.147009

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Dinesh TA, Nair P, Jha V et al (2018) Utilization rate of operation theatres—its evaluation and importance. Int J Sci Res 7(11):1–2. https://doi.org/10.1537/2249555X

    Article  Google Scholar 

  14. Sanjay P, Dodds A, Miller E, Arumugam PJ, Woodward A (2007) Cancelled elective operations: an observational study from a district general hospital. J Health Org Manag 21(1):54–58. https://doi.org/10.1108/14777260710732268

    Article  CAS  Google Scholar 

  15. Silber JH, Rosenbaum PR, Zhang X, Even-Shoshan O (2007) Estimating anesthesia and surgical times from Medicare anesthesia claims. Anesthesiology 106:346–355. https://doi.org/10.1097/00000542-200702000-00024

    Article  PubMed  Google Scholar 

  16. Costa ADS Jr (2017) Assessment of operative times of multiple surgical specialties in a public university hospital. Einstein (Sao Paulo) 15(2):200–205. https://doi.org/10.1590/S1679-45082017GS3902

    Article  PubMed  Google Scholar 

  17. Broka SM, Jamart J, Louagie YAG (2003) Scheduling of elective surgical cases within allocated block-times: can the future be drawn from the experience of the past? Acta Chir Belg 103:90–94. https://doi.org/10.1080/00015458.2003.11679372

    Article  CAS  PubMed  Google Scholar 

  18. Buchanan D (1988) Representing process: the contribution of a re-engineering frame. Int J Oper Prod Manag 18:1163–1188. https://doi.org/10.1108/01443579810236610

    Article  Google Scholar 

  19. van Eijk RP, van Veen-Berkx E, Kazemier G, Eijkemans MJ (2016) Effect of individual surgeons and anesthesiologists on operating room time. Anesth Analg 123(2):445–451. https://doi.org/10.1213/ANE.0000000000001430

    Article  CAS  PubMed  Google Scholar 

  20. Dexter F, Macario A (1996) Applications of information systems to operating room scheduling. Anesthesiology 85:1232–1234. https://doi.org/10.1097/00000542-199612000-00002

    Article  CAS  PubMed  Google Scholar 

  21. Widdison AL (1995) Can we predict when an operating list will finish? Ann R Coll Surg 77(6 Suppl):304–306

    CAS  Google Scholar 

  22. Kendell J, Wildsmith JAW, Gray IG (2000) Costing anaesthetic practice. An economic comparison of regional and general anaesthesia for varicose vein and inguinal hernia surgery. Anaesthesia 55:1106–1113. https://doi.org/10.1046/j.1365-2044.2000.01547.x

    Article  CAS  PubMed  Google Scholar 

  23. Abouleish AE, Dexter F, Whitten CW, Zavaleta JR, Prough DS (2004) Quantifying net staffing costs due to longer-than-average surgical case durations. Anesthesiology 100:403–412. https://doi.org/10.1097/00000542-200402000-00033

    Article  PubMed  Google Scholar 

  24. Costa AS Jr, Leão LE, Novais MA, Zucchi P (2015) An assessment of the quality indicators of operative and non-operative times in a public university hospital. Einstein (Sao Paulo) 13(4):594–599. https://doi.org/10.1590/S1679-45082015GS3289

    Article  PubMed  Google Scholar 

  25. Stepaniak PS, Heij C, Mannaerts GHH, de Quelerij M, de Vries G (2009) Modeling procedure and surgical times for current procedural terminology-anesthesia-surgeon combinations and evaluation in terms of case-duration prediction and operating room efficiency: a multicenter study. Anesth Analg 109:1232–1245. https://doi.org/10.1213/ANE.0b013e3181b5de07

    Article  PubMed  Google Scholar 

  26. Strum DP, Sampson AR, May JH, Vargas LG (2000) Surgeon and type of anesthesia predict variability in surgical procedure times. Anesthesiology 92:1454–1466. https://doi.org/10.1097/00000542-200005000-00036

    Article  CAS  PubMed  Google Scholar 

  27. Vinukondaiah K, Ananthakrishnan N, Ravishankar M (2000) Audit of operation theatre utilization in general surgery. Natl Med J India 13:118–121

    CAS  PubMed  Google Scholar 

  28. Haiart DC, Paul AB, Griffiths JM (1990) An audit of the usage of operating theatre time in a peripheral teaching surgical unit. Postgrad Med J 66:612–615. https://doi.org/10.1136/pgmj.66.778.612

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Strum DP, Vargas LG, May JH, Bashein G (1997) Surgical suite utilization and capacity planning: a minimal cost analysis model. J Med Syst 21(5):309–322. https://doi.org/10.1023/a:1022824725691

    Article  CAS  PubMed  Google Scholar 

  30. Faiz O, Tekkis P, McGuire A, Papagrigoriadis S, Rennie J, Leather A (2008) Is theatre utilization a valid performance indicator for NHS operating theatres? BMC Health Serv Res 8(1):28. https://doi.org/10.1186/1472-6963-8-28

    Article  PubMed  PubMed Central  Google Scholar 

  31. Pandit JJ, Carey A (2006) Estimating the duration of common elective operations: implications for operating list management. Anaesthesia 61:768–776. https://doi.org/10.1111/j.1365-2044.2006.04719.x

    Article  CAS  PubMed  Google Scholar 

  32. Sahran D, Siddharth V, Satpathy S (2019) Are the operation theatres being optimally utilized?—a prospective observational study in a tertiary care public sector hospital. Indian J Surg 82:407–414. https://doi.org/10.1007/s12262-019-01980-7

    Article  Google Scholar 

  33. Walsh U, Alfhaily F, Gupta R, Vinayagam D, Whitlow B (2010) Theatre sending: how long does it take and what is the cost of late starts? Gynecol Surg 7(3):307–310. https://doi.org/10.1007/s10397-010-0577-0

    Article  Google Scholar 

  34. Oluwadiya KS, Osinaike BB, Eziyi AK, Oyebamiji EO, Kolawole IK (2012) A theatre time utilization survey in a university teaching hospital from a developing country. J Anesth Clin Res 3(5):1–4. https://doi.org/10.4172/2155-6148.1000210

    Article  Google Scholar 

  35. Barr A, McNeilly RH, Rogers S (1982) Use of operating theatres. Br Med J (Clin Res Ed) 285(6347):1059–1061. https://doi.org/10.1136/bmj.285.6347.1059

    Article  CAS  PubMed  Google Scholar 

  36. Audit Commission (2004) Introducing payment by results: getting the balance right for the NHS and taxpayers London: HMSO. https://www.gov.uk/government/publications/audit-commission-annual-report-and-accounts-2012-to-2013

  37. Eappen S, Flanagan H, Bhattacharyya N (2004) Introduction of anesthesia resident trainees to the operating room does not lead to changes in anesthesia-controlled times for efficiency measures. Anesthesiology 101:1210–1214. https://doi.org/10.1097/00000542-200411000-00022

    Article  PubMed  Google Scholar 

  38. Urman RD, Sarin P, Mitani A, Philip B, Eappen S (2012) Presence of anesthesia resident trainees in day surgery unit has mixed effects on operating room efficiency measures. Ochsner J 12:25–29

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Oncology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India

    Rohit Jindal, Pinakin Patel, Kamal Kishor Lakhera & Suresh Singh

  2. Department of Anaesthesiology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India

    Chanchal Gulati

  3. Department of Surgical Oncology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India

    Raj Govind Sharma

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  1. Rohit Jindal
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Contributions

RJ: Concept, Design, Literature search, Writing; PP: Concept, Analysis and/or interpretation; KKL: Analysis and/or interpretation; C: Literature search, Writing; SS: Supervision, Critical review. RGS: Critical review, Supervision.

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Correspondence to Rohit Jindal.

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The research involved human Participants and a well informed consent was taken from each individual. Departmental ethical clearance was obtained. The study was a part of the regular departmental audit.

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Jindal, R., Patel, P., Lakhera, K.K. et al. Assessment of Operative Time for Lip and Oral Cancers: A Tool to Improve Operative Room Efficiency. Indian J Otolaryngol Head Neck Surg 75, 219–226 (2023). https://doi.org/10.1007/s12070-022-03135-9

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