title: Increased mean time from end of surgery to operating room exit in a historical cohort of cases with prolonged time to extubation.
abstract: BACKGROUND
  Prolonged time to extubation has been defined as the occurrence of a ≥ 15-minute interval from the end of surgery to removal of the tracheal tube. We quantified the increases in the mean times from end of surgery to exit from the OR associated with prolonged extubations and tested whether the increases were economically important (≥ 5 minutes).
  
  
  METHODS
  Anesthesia information management system data from 1 tertiary hospital were collected from November 2005 through December 2012 (i.e., sample sizes were N = 22 sequential quarters). Cases were excluded in which the patient's trachea was not intubated or extubated while physically in the operating room (OR). For each combination of stratification variable (below) and quarter, the mean time from end of surgery to OR exit was calculated for the extubations that were not prolonged and for those that were prolonged. Results are reported as mean ± SEM, with "at least" denoting the lower 95% confidence interval.
  
  
  RESULTS
  The mean times from end of surgery to OR exit were at least 12.6 minutes longer for prolonged extubations when calculated with stratification by duration of surgery and prone or other positioning (13.0 ± 0.1 minutes), P < 0.0001 compared to 5 minutes (i.e., times were substantively long economically). The mean times were at least 11.7 minutes longer when calculated stratified by anesthesia procedure code (12.4 ± 0.4, P < 0.0001) and at least 11.3 minutes longer when calculated stratified by surgeon (12.4 ± 0.6, P < 0.0001).
  
  
  CONCLUSIONS
  We recommend that anesthesia providers document the times of extubations and monitor the incidence of prolonged extubations as an economic measure. This would be especially important for providers at facilities with many ORs that have at least 8 hours of cases and turnovers.
authors.affiliation: From the *Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa; and †Department of Anesthesiology, Jefferson Medical College, Philadelphia, Pennsylvania.
authors.forename: Franklin
authors.initials: F
authors.lastname: Dexter
authors.forename: Richard H
authors.initials: RH
authors.lastname: Epstein
mesh_terms: D060666:Airway Extubation / Q000191:economics; D000761:Anesthesia Department, Hospital; D000762:Anesthesia Recovery Period; D001071:Appointments and Schedules; D017721:Hospital Costs; D006801:Humans; D009870:Operating Room Information Systems; D009873:Operating Rooms / Q000191:economics; D010360:Patient Transfer / Q000191:economics; D015143:Philadelphia; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013997:Time Factors