A comparison of high efficiency and traditional benign anorectal operating room days: a cohort study.

Background: High efficiency (HE) operating rooms (OR) describe the intentional grouping of surgical cases according to case complexity, anesthetic, and nursing requirement. This approach has the potential to increase case volumes while protecting patient outcomes.

Objective: Comparison of a HE to a Traditional model on surgical efficiency metrics, patient outcomes, and total costs in benign anorectal surgery.

Methods: This single-center retrospective cohort study was conducted at a Canadian tertiary care academic center. Cases booked for the colorectal ambulatory surgical list during the pre-intervention (Traditional) phase spanning 2021-2022 were compared to the post-intervention (HE) phase implemented in 2023. The primary outcome of this study was surgical efficiency, defined as the number of cases completed per surgical list. Secondary outcomes included patient outcomes and hospital costs.

Results: 257 patients were included in this study (Traditional 125 cases in 24 OR lists, HE 132 cases in 19 OR lists). Mean age (Traditional 52.2 vs. HE 49.1, p = 0.130) and male sex (57.6% vs. 56.8%, p = 0.899) were similar between groups. In the HE phase, more benign anorectal cases were completed per day (5.2 cases vs. 6.9cases, p < 0.001). The HE model saved 13 min (72.0 min vs 59.7 min, p < 0.001) per case. This included a decrease in surgical time (26.8 min vs. 21.3 min, p = 0.069), anesthetic time (20.2 min vs. 16.3 min, p < 0.001), and turnover time (22.6 min vs.18.5 min, p < 0.001). Perioperative outcomes, such as total PACU time (87.3 min vs 103.2 min, p = 0.080) and time to discharge (72.8 min vs 82.5 min, p = 0.262), were similar between phases. A HE model resulted in cost savings of approximately $368.13 per case ($1575 vs. $1207, p = 0.0013).

Conclusion: Implementation of a HE model resulted in more cases being completed, similar patient outcomes, and decreased costs of care. Adoption of this model should be considered for non-complex surgical procedures, especially in resource-limited settings.