1412. OR Time Estimation in Neurosurgery

Authors: Thomas DiChiara; Daniel Kim; Fedor Panov, MD (New York, NY)

Introduction:

Operating room (OR) time is a precious hospital commodity. Surgeries often have to be delayed or rescheduled increasing cost to the hospital, complicating the workflow of the surgical team, and impacting care of the patient. Neurosurgical operating time can vary widely. Coordination between Anesthesiology, hospital staff, and outpatient clinics running in parallel is difficult. Efficient OR usage is the most significant aspect of a successful neurosurgery department. We sought to analyze differences in estimated and actual OR times in select neurosurgical procedures as the first step to improving our ability to predict case lengths.

Methods:

Quality control information was obtained through hospital quality assurance department from April 2018 to August 2018. Neurosurgical operations were divided into spine, epilepsy, general neurosurgery. Spine was subdivided into one-level anterior neck fusions(ACDF) and microdiscectomy. Epilepsy was subdivided into stereoelectroencephalography(SEEG), SEEG removal, and RNS device implantation. Shunts were used to reference the general neurosurgery category. Each operation was analyzed for statistical outliers and deviation from the estimated completion time. Operations were averaged with underestimation of OR time meaning the case went longer than expected, and vice versa for overestimation.  

Results:

Spine showed the least deviation from estimation time. ACDF(13 total) were on average 2 minutes underestimated and microdiscs(38) were 30 minutes underestimated. General neurosurgery intracranial shunts(7) were on average 60 minutes underestimated. SEEG(21) were 28 minutes longer than predicted while SEEG removals were significantly overestimated. RNS implantation(5) was underestimated by 90 minutes.

Conclusion:

A more efficient OR can be achieved through accurate scheduling. Most neurosurgical operations deviated significantly from their projected times. Though the case lengths would not change, an accurate appraisal of each operation’s time would significantly improve the function of the surgical team and the patient experience.