title: Increased efficiency of endocrine procedures performed in an ambulatory operating room.
abstract: BACKGROUND
  Thyroid and parathyroid procedures historically have been viewed as inpatient procedures. Because of the advancements in surgical techniques, these procedures were transferred from the inpatient operating room (OR) to the outpatient OR at a single academic institution approximately 7 y ago. The goal of this study was to determine whether this change has decreased turnover times and maximized OR utilization.
  
  
  METHODS
  We performed a retrospective review of 707 patients undergoing thyroid (34%) and parathyroid (66%) procedures by a single surgeon at our academic institution between 2005 and 2008. Inpatient and outpatient groups were compared using Student t-test, chi-square test, or the Kruskal-Wallis test where appropriate. Multiple regression analysis was used to determine how patient and hospital factors influenced turnover times.
  
  
  RESULTS
  Turnover times were significantly lower in the outpatient OR (mean 18 ± 0.7 min) when compared with the inpatient OR (mean 36 ± 1.4 min) (P < 0.001). When compared by type of procedure, all turnover times remained significantly lower in the outpatient OR. Patients in both ORs were similar in age, gender, and comorbidities. However, inpatients had a higher mean American Society of Anesthesiologists score (2.30 versus 2.13, P < 0.001) and were more likely to have an operative indication of cancer (23.1% versus 9.2%, P < 0.001). Using multiple regression, the inpatient OR remained highly significantly associated with higher turnover times when controlling for these small differences (P < 0.001).
  
  
  CONCLUSIONS
  Endocrine procedures performed in the outpatient OR have significantly faster turnover times leading to cost savings and greater OR utilization for hospitals.
authors.affiliation: Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin 53792-7375, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Clark
authors.forename: David F
authors.initials: DF
authors.lastname: Schneider
authors.forename: Sara
authors.initials: S
authors.lastname: Vrabec
authors.forename: Philip S
authors.initials: PS
authors.lastname: Bauer
authors.forename: Herbert
authors.initials: H
authors.lastname: Chen
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Sippel
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000706:statistics & numerical data; D000556:Ambulatory Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data*; D017046:Cost Savings; D013507:Endocrine Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010045:Outpatients / Q000706:statistics & numerical data; D010279:Parathyroid Diseases / Q000191:economics / Q000601:surgery*; D016105:Parathyroidectomy / Q000191:economics / Q000706:statistics & numerical data; D012044:Regression Analysis; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000191:economics / Q000601:surgery*; D013965:Thyroidectomy / Q000191:economics / Q000706:statistics & numerical data; D014600:Utilization Review
keywords: Ambulatory procedure; Operating room efficiency; Outpatient operating room; Parathyroidectomy; Process measures; Resource utilization; Thyroidectomy; Turnover time