A regional anesthesia-based “swing” operating room model reduces non-operative time in a mixed orthopedic inpatient/outpatient population

Abstract

We recently reported on the efficacy of a new "swing" room model involving two alternating ORs and regional anesthesia in increasing operating room (OR) throughput in a dedicated ambulatory orthopedic surgery facility. The purpose of this study was to evaluate this model in a main OR suite setting with typical mixed inpatient/outpatient cases. We conducted a retrospective matched-pair cohort study of 133 upper extremity surgery patients treated in the swing room model under ultrasound-guided brachial plexus blockade. We compared this cohort with case-matched historical controls treated in the traditional single OR model under general anesthesia. The primary endpoint was non-operative time, defined as the interval between skin closure and incision in the following case. Secondary endpoints included throughput estimated as the median number of cases per eight-hour day, postanesthesia care unit (PACU) bypass rates, and postoperative pain/nausea and vomiting (PONV) intervention rates. Compared with the control group, non-operative times in the swing room group were faster (swing: median 19 min; interquartile range [IQR 8-31] vs control: median 57 min; IQR [49-65]; P < 0.0001). In the swing room model, the estimated daily throughput was 33% greater (swing: median 5.6 cases; IQR [5.0-6.2] vs control: median 4.2 cases; IQR [4.0-4.4]; P < 0.0001), and the PACU bypass rate was higher (swing: 60% vs control: 0%; P < 0.0001). Fewer patients received postoperative opioids (swing: 20% vs control: 82%; P < 0.0001) and treatment for PONV (swing: 2% vs control: 20%; P < 0.0001) in the swing room model. The implementation of a "swing" room care model based on ultrasound-guided regional anesthesia in a typical mixed inpatient/outpatient population decreased non-operative times, increased throughput, and improved recovery profiles compared with case-matched historical controls in the traditional model under general anesthesia.