1037. Can Anesthesia be Blamed for Prolonged Preoperative Time?

Authors: Deen Garba; Joshua Loewenstein, MD; Carolyn Quinsey, MD (Greensboro, NC)


Suboptimal communication can lead to preventable delays throughout surgical cases. In our study, we aimed to identify factors delaying surgery in the immediate preoperative period. We had a specific interest in the anesthesia release to incision time, as well as preoperative expectations of both the neurosurgery and anesthesia providers.  Additionally, we introduced new communication goals prior to induction, to examine the impact on preoperative efficiency.


The study is a prospective cohort analysis evaluating communication in the immediate preoperative period. In 42 consecutive cranial neurosurgical cases, a questionnaire was given to both the neurosurgical and anesthesia residents and their responses were recorded.


Comparing the cohorts before and after implementing the checklist, no difference in release to incision time was observed. However, the difference in estimated procedure time between neurosurgery and anesthesia providers was significantly decreased after implementation of the formal pre-induction checklist (p=.039).  Further, there was a trend towards better agreement in estimated blood loss after implementation, although results did not achieve statistical significance (p=.15). The most common delays in the preoperative time period were re-taping lines, and repositioning arms.  These delays decreased by 64% after the new communication goals were executed. 


While no improvement in release to incision time was noted during our study, there was evidence that communication between teams had improved after implementation of the checklist.  There was a reduction in the drivers of time delays such as repositioning of arms and re-taping of lines. Additionally we observed less discrepancy in estimated case length and blood loss, suggesting focused communication goals synergized expectations of the neurosurgical and anesthesia teams. As anesthetic release to incision time remain high in our institution, further efforts will be made to reduce delays and remove inefficiencies.