Abstract
Background
This study aimed to characterize the types of intraoperative delays during robotic-assisted
thoracic surgery, operating room staff awareness/perceptions of delays, and cost impact
of delays on overall operative costs.
Methods
Robotic-assisted thoracic surgery cases from May to August 2019 were attended by 3
third-party observers to record intraoperative delays. The postoperative surveys were
given to operating room staff to elicit perceived delays. Observed versus perceived
delays were compared using the McNemar test. Direct costs and charges per delay were
calculated.
Results
Forty-four cases were observed, of which a majority were lobectomies (n = 38 [86%]). A total of 71 delays were recorded by observers, encompassing 75% of
cases (n = 33), with an average delay length of 3.6 minutes (±5.3 minutes). The following
delays were observed: equipment failure (n = 40, average delay length 5.0 minutes (±6.5 minutes), equipment missing (n = 15, 2.2 minutes [±1.4 minutes]), staff unfamiliarity with equipment (n = 4, 3.4 minutes [± 1.5 minutes]), and other (n = 12, 4.5 minutes [±5.3 minutes]). The detection rates for any intraoperative delay
were consistently lower for all of the operating room team members compared with observers,
including surgeons (34.3% vs 77.1%; P = .0003), first assistants (41.9% vs 74.2%; P = .0075), surgical technologists (39.4% vs 72.7%; P = .0045), and circulating nurses (41.18% vs 76.47% minutes; P = .0013). The average operating room variable direct cost of delays based on the
average total delay length per case was $225.52 (±$350.18) and was 1.6% (range 0–10.6%)
of the total case charges.
Conclusion
The lack of perception of intraoperative delays hinders operating teams from effectively
closing the variable cost gaps. Future studies are needed to explore methods of increasing
perception of delays and opportunities to improve operating room efficiency.
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Article info
Publication history
Published online: August 12, 2022
Accepted:
June 30,
2022
Footnotes
D.M.K. and R.L.A. both contributed equally to this work and should be regarded as co-first authors.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
