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Published on: October 23, 2019
Spinal anesthesia in a designated block bay for total joint arthroplasty: improving operating room efficiency
Ryland Kagan1, Stephanie Zhao2, Andrew Stone2
1Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA kagan@ohsu.edu.
Utilizing a block bay for spinal anesthesia in total joint arthroplasty (TJA) improved operating room start times and reduced general anesthesia conversions. However, its impact on time to incision was minimal.
Area of Science:
- Anesthesiology
- Orthopedic Surgery
- Health Services Research
Background:
- Optimizing operating room (OR) efficiency for total joint arthroplasty (TJA) is complex.
- Evaluating novel anesthetic protocols can enhance surgical workflow.
- Spinal anesthesia is a common anesthetic choice for TJA.
Purpose of the Study:
- To assess the impact of performing spinal anesthesia in a designated block bay (BBSA) versus the operating room (ORSA) on TJA efficiency.
- To determine if BBSA reduces time to incision, improves first case start time, and decreases conversion to general anesthesia (GA).
Main Methods:
- A retrospective cohort study compared 86 TJA cases with BBSA to 344 TJA cases with ORSA.
- Data analyzed included time to incision, first case start time, and conversion to GA.
- Statistical methods included linear mixed effects models and Wilcoxon rank-sum and Fisher's exact tests.
Main Results:
- The BBSA group showed a statistically significant reduction in time to incision (5.37 min, p=0.018).
- First case start time was significantly improved in the BBSA group (median 30.0 min vs 40.5 min, p<0.0001).
- Conversion to GA was significantly lower in the BBSA group (2.33% vs 10.47%, p=0.018).
Conclusions:
- Block bay spinal anesthesia (BBSA) is associated with improved first case start times and reduced conversion to general anesthesia for TJA.
- The effect of BBSA on time to incision was limited, with minor improvements on single OR days.
- Further investigation is warranted to fully understand the efficiency gains of BBSA in TJA procedures.
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