Simple Modifications in Operating Room Processes to Reduce the Times and Costs Associated with Robot-Assisted Laparoscopic Radical Prostatectomy
Simple Modifications in Operating Room Processes to Reduce the Times and Costs Associated with Robot-Assisted Laparoscopic Radical Prostatectomy
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DOI：
10.1089/end.2010.0534
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发表时间：
2011-06-01
影响因子：
2.7
通讯作者：
Nadler, Robert B.
中科院分区：
文献类型：
--
作者：
Rebuck, David A.;Zhao, Lee C.;Nadler, Robert B.
背景与目的：机器人辅助腹腔镜根治性前列腺切除术（RALRP）是前列腺癌患者最昂贵但最常见的手术治疗方法。此外，尽管缺乏证据表明其功能和肿瘤优于其他治疗方法，但其受欢迎程度仍在继续增长。因此，我们修改了手术室（OR）流程，以确定在学术环境中与RALRP相关的时间和成本是否可以减少。患者和方法：实施手术室流程的四项修改：学员遵守以时间为导向的手术目标；使用专门的麻醉小组；在病人周转期间，由护理人员和泌尿科人员同时处理；识别和消除未使用的一次性器械。测量手术总时间、麻醉时间和手术室周转时间。还测量了工资、手术供应、手术室时间和麻醉费用。对100例RALRP病例进行了修改前后的比较。结果：行RALRP的患者在修改前后均相似。总手术时间、麻醉时间和周转时间分别减少17.4 （6.8%,P = 0.041）分钟、4.5 （19.1%,P = 0.006）分钟和12.1 （28.1%,P = 0.005）分钟。工资、手术用品和手术室费用分别减少了330美元（25%）、609美元（15.7%）和1638美元（27.7%）。麻醉费用在财政上没有显著变化。结论：通过简单的修改，可以通过减少相关的时间和成本来提高rralrp的效率。这些修改是在学术环境中实施的，但可以在任何机构中使用。这些修改是提高RALRP与其他治疗方式的成本竞争力的初步尝试。
Background and Purpose: Robot-assisted laparoscopic radical prostatectomy (RALRP) is the most expensive, yet most common, surgical treatment for patients with prostate cancer. Furthermore, its popularity continues to grow despite the lack of evidence for functional and oncologic superiority over other treatments. As a result, we modified operating room (OR) processes to determine if the times and costs that are associated with RALRP in an academic setting could be reduced.Patients and Methods: Four modifications in OR processes were implemented: Trainee adherence to time-oriented surgical goals; use of a dedicated anesthesia team; simultaneous processing by nursing and urology house staff during case turnover; and identification and elimination of unused disposable instruments. Total surgical, anesthesia, and OR turnover times were measured. Payroll, surgical supply, OR time, and anesthesia costs were also measured. One hundred RALRP cases before and after the modifications were implemented were compared.Results: Patients undergoing RALRP were similar both before and after the modifications were implemented. Total surgical, anesthesia, and turnover times were reduced by 17.4 (6.8%, P = 0.041), 4.5 (19.1%, P = 0.006), and 12.1 (28.1%, P = 0.005) minutes, respectively. Payroll, surgical supply, and OR costs were reduced by $330 (25%), $609 (15.7%), and $1638 (27.7%), respectively. There was no fiscally significant change in anesthesia costs.Conclusions: Using simple modifications, it is possible that RALRP efficiency can be improved by decreasing its associated times and costs. These modifications were implemented in an academic setting but may be used in any institution. These modifications represent an initial attempt to improve RALRP cost-competitiveness with other treatment modalities.