title: Delayed operating room availability significantly impacts the total hospital costs of an urgent surgical procedure.
abstract: BACKGROUND
  Financial pressures drive efforts to optimize hospital resource use, but inefficiencies occur in systems as volume nears total capacity. We examined how operating room use impacts efficiency and costs of treating an urgent surgical condition.
  
  
  METHODS
  A retrospective review of patients who underwent appendectomy for appendicitis at a single hospital from 2004 to 2009 was performed. Patient demographics, operative characteristics, pathologic diagnoses, hospital time intervals, and costs were analyzed. Gap time (time from case booking to surgery start) was used to measure operating room availability.
  
  
  RESULTS
  In all, 453 patients met inclusion criteria. Longer gap times were associated with increased hospital-based costs. A gap time of greater than 2 h was associated with 39% higher costs to the hospital, which could not be accounted for by any single cost center. The patients in the 2 groups had similar medical and surgical complexity, as well as similar clinical outcomes and hospital duration of stay. Gap times were greatest during peak elective operating room activity (7 am to 11 pm); however, the total hospital costs were not related to the time of day of the case.
  
  
  CONCLUSIONS
  A short delay in operating room availability for urgent cases is associated with significantly increased total hospital costs. Our data suggest this finding is attributable to inefficient care when the operating room volume nears total capacity.
authors.affiliation: Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. dhuparr@upmc.ed
authors.forename: Rajeev
authors.initials: R
authors.lastname: Dhupar
authors.forename: John
authors.initials: J
authors.lastname: Evankovich
authors.forename: John R
authors.initials: JR
authors.lastname: Klune
authors.forename: Luis G
authors.initials: LG
authors.lastname: Vargas
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Hughes
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000191:economics*; D001064:Appendicitis / Q000601:surgery*; D017598:Efficiency, Organizational / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D008875:Middle Aged; D009873:Operating Rooms / Q000191:economics*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult