• Rajeev Dhupar, John Evankovich, John R Klune, Luis G Vargas, and Steven J Hughes.
• Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. dhuparr@upmc.ed
• Surgery. 2011 Aug 1; 150 (2): 299-305.

BackgroundFinancial pressures drive efforts to optimize hospital resource use, but inefficiencies occur in systems as volume nears total capacity. We examined how operating room use impacts efficiency and costs of treating an urgent surgical condition.MethodsA retrospective review of patients who underwent appendectomy for appendicitis at a single hospital from 2004 to 2009 was performed. Patient demographics, operative characteristics, pathologic diagnoses, hospital time intervals, and costs were analyzed. Gap time (time from case booking to surgery start) was used to measure operating room availability.ResultsIn all, 453 patients met inclusion criteria. Longer gap times were associated with increased hospital-based costs. A gap time of greater than 2 h was associated with 39% higher costs to the hospital, which could not be accounted for by any single cost center. The patients in the 2 groups had similar medical and surgical complexity, as well as similar clinical outcomes and hospital duration of stay. Gap times were greatest during peak elective operating room activity (7 am to 11 pm); however, the total hospital costs were not related to the time of day of the case.ConclusionA short delay in operating room availability for urgent cases is associated with significantly increased total hospital costs. Our data suggest this finding is attributable to inefficient care when the operating room volume nears total capacity.Copyright © 2011 Mosby, Inc. All rights reserved.

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