Process analysis in outpatient knee surgery: effects of regional and general anesthesia on anesthesia-controlled time.
BACKGROUND
The performance of anesthetic procedures before operating room entry (e.g., with either general or regional anesthesia [RA] induction rooms) should decrease anesthesia-controlled time in the operating room. The authors retrospectively studied the associations between anesthesia techniques and anesthesia-controlled time, evaluating one surgeon performing a single procedure over a 3-yr period. The authors hypothesized that, using the anesthesia care team model, RA would be associated with reduced anesthesia-controlled time compared with general anesthesia (GA) alone or combined general-regional anesthesia (GA-RA).


METHODS
The authors queried an institutional database for 369 consecutive patients undergoing the same procedure (anterior cruciate ligament reconstruction) performed by one surgeon over a 3-yr period (July 1995 through June 1998). Throughout the period of study, anesthesia staffing consisted of an attending anesthesiologist medically directing two nurse anesthetists in two operating rooms. Anesthesia-controlled time values were compared based on anesthesia techniques (GA, RA, or GA-RA) using one-way analysis of variance, general linear modeling using time-series and seasonal adjustments, and chi-square tests when appropriate. P < 0. 05 was considered significant.


RESULTS
RA was associated with the lowest anesthesia-controlled time (11.4 +/- 1.3 min, mean +/- 2 SEM). GA-RA (15.7 +/- 1.0 min) was associated with lower anesthesia-controlled time than GA used alone (20.3 +/- 1.2 min).


CONCLUSIONS
When compared with GA without an induction room for outpatients undergoing anterior cruciate ligament reconstruction, RA with an induction room was associated with the lowest anesthesia- controlled time. Managers must weigh the costs and time required for anesthesiologists and additional personnel to place nerve blocks or induce GA preoperatively in such a staffing model.
Williams
B A
BA
Same-Day Surgical Services, University of Pittsburgh Medical Center, PA 15213-2582, USA. williamsba@anes.upmc.edu
Kentor
M L
ML
Williams
J P
JP
Figallo
C M
CM
Sigl
J C
JC
Anders
J W
JW
Bear
T C
TC
Tullock
W C
WC
Bennett
C H
CH
Harner
C D
CD
Fu
F H
FH
D000328:Adult; D000556:Ambulatory Surgical Procedures; D000704:Analysis of Variance; D000765:Anesthesia, Conduction / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D019091:Critical Pathways; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team; D020250:Postoperative Nausea and Vomiting; D017064:Process Assessment, Health Care; D013997:Time Factors