The Impact of Extubation Setting on Operating Room Efficiency, Hospital Costs, and Patient Safety in a Children's Hospital

Abstract

Introduction: Operating room (OR) throughput and efficiency is a key driver of hospital costs. We sought to evaluate the efficacy, safety, and cost implications of a practice of post-anesthesia care unit (PACU) extubation for 4 common pediatric surgical operations. Methods: The records of 6,956 children who underwent inguinal hernia repair, laparoscopic appendectomy, pyloromyotomy, and tonsillectomy/adenoidectomy at a free-standing children’s hospital between July 2018 and June 2020 were reviewed. OR flow time metrics and postoperative airway interventions were assessed. Based on a 2014 study, 1 minute of operative time was assessed at $37. Exclusion criteria included PACU holds and direct transfers from the OR to an inpatient unit. Results: There were 5,245 procedures analyzed. All patients were extubated in the PACU except during periods of elevated COVID-19 transmission risk or when the PACU was understaffed. The mean time from procedure completion to leaving the OR was between 3.7 and 4.8 minutes for patients extubated in the PACU and 10.0 and 13.0 minutes for those extubated in the OR. PACU respiratory events were minor, infrequent, and of similar incidence after PACU or OR extubation. Conclusion: We found PACU extubation to be safe and effective in reducing patient time in the OR by up to 13 minutes. We project that our hospital has saved more than $1 million in 2 years due to the time savings associated with only these 4 common operations. In a time of limited resources, a policy of PACU extubation could have a substantial impact on the financial viability of children’s hospitals.