[Can the time between interventions be reduced in the operating theater? Prospective study]

BACKGROUND AND AIM OG THE STUDY: The interval between two surgical interventions is increasing because of the introduction of successive safety measures. Our aims were to prospectively evaluate the different intervals between two elective abdominal surgical interventions and to determine which factors were associated with a decrease in the inter-operative time delay.

Between November 2001 and July 2002, 102 inter-operative periods were prospectively analyzed. All the interventions involved either an elective, planned laparotomy or a laparoscopic procedure, under general anesthesia. The interval between two operations was divided into three periods: the departure of the patient operated on; the empty theatre; the entry of the next patient. The collected data were compared to retrospective data from 90 days and 10 years prior to the study.

The average time delay between two interventions was 63.5 min (40-107) vs. 72.3 min (30-91) 3 months earlier and 32 min (10-105) (P = 0.001) 10 years earlier. The average time from skin closure to the departure of the patient from the operating room was 15.7 min (5-35), of which 3.5 min (1-15) was surgically related, 7.7 min (1-26) was anesthetic time (waking the patient) and 4.5 min (2-15) for taking the patient out of theatre. The average duration of the period called 'empty theatre' was 13.7 min (7-65), of which 8.9 min (4-15) was for cleaning the operating room. Finally, the last period lasted, on average, 32.1 min (11-69), of which 16.7 min (3-49) was anesthetic time, 2.3 min (2-15) for positioning the patient and 9.9 min was surgically related. In this study, the shortest time between interventions was 40 min and the longest was 107 min. The theoretical shortest time possible (summing the lowest values for each period) was 19 min, while the longest (summing the largest values) was 169 min. Anesthetic time represented 38% of the entire inter-operative period, while surgical time represented 21%. Laparoscopic procedures did not significantly effect the inter-operative interval.

Because of the multiple safety measures required, the inter-operative delay is continuously increasing and, in this study, was equivalent to the actual operative time of the surgical procedures. The inter-operative period cannot be shortened below 20 min or so. The reduction of this period would only be possible by involving and coordinating the different personnel that contribute to performing an operation, by optimizing the procedures and by harmonizing materials. The lack of interest and the lack of concern for the most efficient use of resources within the public hospitals, as well as the recent legal and social constraints introduced in France, are the main factors preventing progress in these areas.