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BACKGROUND/RATIONALE:
Operating room (OR) time is a scarce and expensive resource that may account for 33% or more of the costs of providing care to surgical patients. OR time must therefore be utilized efficiently to optimize delivery of surgical care. A finding of significant variation among institutions in the use of expensive OR resources (for similar cases) may indicate important opportunities to improve structure or processes of care.
Objective(s):
This study makes innovative use of existing VA data sources: (1) To measure national and regional reference values for surgical case length for common operative procedures within VA, and to determine risk-adjusted case lengths. These data will be used to identify institutional variations in care. (2) To characterize the risk-adjusted case-volume:surgical-time relationship for common operations, and to determine whether high-volume hospitals deliver surgical care more efficiently. (3) To validate methods for automated measuring and tracking of measures of OR efficiency.
OBJECTIVE(S):
This study will make innovative use of existing VA data sources: (1) To measure national and regional reference values for surgical case length for common operative procedures within VA, and to determine risk-adjusted case lengths. These data will be used to identify institutional variations in care. (2) To characterize the risk-adjusted case-volume:surgical-time relationship for common operations, and to determine whether high-volume hospitals deliver surgical care more efficiently. (3) To validate methods for automated measuring and tracking of measures of OR efficiency.
METHODS:
Data are drawn from the National Surgical Quality Improvement Program (NSQIP) database and from the VA surgical package. Multivariate regression methods are used to identify risk factors for surgical case duration.
Findings / Results:
Radical Retropubic Prostatectomy (RPP) surgeries performed within VA were reviewed. Between October 1,2001 and September 30, 2004, a total of 5,070 RRP surgeries met inclusion criteria. After adjustment for case-mix, academic training institutions had longer operative times (3.2 hours vs 2.4 hours, p <0.01) but shorter length of stay (3.4 days vs 4.2 days, p <0.01). Surgery at academic institutions was not associated with greater risk of transfusion (p= 0.36), reoperation (p = 0.93), complications (p = 0.53) or readmissions (p = 0.97). Among the academic institutions, however, low versus high hospital RRP volume was associated with longer LOS (3.7 vs 3.1 days, p = 0.02) and higher transfusion rate (29.6% vs 18.2%, p = 0.02). Within the VA system, academic training institutions have longer operative times for RRP, but shorter LOS. Among the same institutions, high-volume hospitals tend to have lower transfusion rates and shorter LOS. Clustering of outcomes at the hospital level suggests that unmeasured institutional factors are key determinants of clinical and resource-related outcomes.
FINDINGS/RESULTS:
Preliminary data from one VA medical center suggest that surgical case duration within VA may be 30% to 90% longer than Medicare RBRVS values.
IMPACT:
National standards for surgical case duration in VA do not currently exist. This project will produce National VA benchmark data on surgical case duration and will validate techniques for tracking turnover time and other measures of operating room efficiency.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems
DRE:
Quality of Care, Communication and Decision Making
Keywords:
Clinical practice guidelines, Utilization patterns, Care Management
MeSH Terms:
none
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