Operating Room Research Articles

Outpatient total hip arthroplasty: robotic assistance reduces 90-Day postoperative events and optimizes outpatient care.

The adoption of robotic-assisted total hip arthroplasty (THA) is increasingly widespread, yet its influence on outcomes in outpatient surgery remains uncertain. This study aimed to evaluate whether robotic assistance reduces the rate of 90-day postoperative events in patients undergoing outpatient THA, compared to those in inpatient procedures. This historical-prospective cohort study analyzed 706 primary THA cases performed between January 2017 and January 2023 by three senior surgeons. Patients were grouped into outpatient (n = 132) and inpatient (n = 576) cohorts. From December 2019, robotic-assisted THA using the MAKO™ system was implemented. Propensity score matching was used to minimize baseline differences between groups. The primary outcome was the occurrence of any event within 90 days post-surgery, including readmissions, reoperations, and other complications. Secondary outcomes included functional scores, length of hospital stay, and intraoperative factors such as blood loss and Operative Room (OR) time. No significant differences were found between inpatient and outpatient groups in terms of gender, age, BMI, ASA score, or surgeon. The 90-day event rates were similar between the two groups (8.59% vs. 9.38%, p > 0.999). However, outpatient THA was associated with lower blood loss (p = 0.02) and shorter hospital stays (p < 0.001). Multivariate analysis identified prolonged OR time (> 2h), BMI ≥ 25, and manual surgical techniques as significant risk factors for 90-day events. Robotic-assisted surgery, although not statistically significant (p = 0.105), showed a trend towards reducing complications in outpatient THA. Outpatient THA is a safe alternative to inpatient surgery, with no significant difference in 90-day postoperative events. Robotic-assisted surgery appears to reduce complications, particularly in the outpatient setting, and may optimize outpatient care pathways. Further research is needed to confirm these findings and explore long-term outcomes. III.

Correlation between uterine volume and intrauterine adhesion: a propensity score matching analysis

Objective: To investigate the correlation between uterine volume and intrauterine adhesion (IUA). Methods: From June 2018 to November 2019, totally 7 007 patients who underwent hysteroscopy in outpatient operating rooms of Gynecological Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital were retrospectively analyzed. Patients of reproductive age with IUA without uterine fibroids and adenomyosis were selected as IUA group, and patients of reproductive age without uterine fibroids and adenomyosis without IUA during the same period were selected as the control group. The propensity score matching (PSM) method was used to perform 1∶1 matching for the two groups of patients, matching variables included age, height, weight, body mass index (BMI), gravidity, parity, and number of abortion curettage. Whether there was any difference in uterine volume between the two groups of patients was compared, and whether uterine volume was an influencing factor of IUA was explored. The patients in IUA group were also categorized into mild, moderate and severe to explore whether uterine volume influenced the severity of IUA. Results: (1) After inclusion and exclusion criteria, 351 patients were included in IUA group and 2 986 patients in the control group. With PSM, 327 patients in IUA group and 327 patients in the control group were finally enrolled in this study. There were no statistically significant differences in age, height, weight, BMI, gravidity, parity, and number of abortion curettage between the two groups of patients after matching (all P>0.05). (2) After PSM, there was a significant difference between the uterine volume of IUA group (median: 44.23 cm3) and the uterine volume of the control group (median: 57.20 cm3; P<0.001). (3) Reduced uterine volume (OR=0.961, 95%CI: 0.952-0.970) was an independent risk factor for IUA (P<0.001). (4) Uterine volume had a significant effect on the severity of IUA (P<0.001), the larger the uterine volume (B=-0.030, 95%CI: -0.044 to -0.017), the less severe the IUA. Conclusions: Reduced uterine volume is an independent risk factor for IUA, and uterine volume has a significant effect on the severity of IUA. In patients with small uterine volume size, primary and secondary prevention of IUA should be emphasized.

Cost and outcomes of side-to-side versus end-to-end anastomosis in right colectomy: a retrospective cohort study.

The optimal anastomotic configuration for right-sided colectomies remains controversial, with comparable postoperative outcomes across techniques. Thus, economic considerations may play a larger role in decision-making within cost-constrained healthcare settings. This retrospective cohort study evaluated right-sided colectomies with ileocolic anastomosis at a Swiss tertiary center between 2016 and 2021. We compared costs and outcomes among three anastomotic techniques: end-to-end (EE), side-to-side stapled (SSS), and side-to-side hand-sewn (SSH). Out of 468 patients (mean age 67.7 ± 16.2years; 51.7% female), EE was used in 95 cases (20.3%), SSS in 191 (40.8%), and SSH in 182 (38.9%). The majority (72.0%) underwent elective surgery. Insurance coverage included basic (62.2%), semi-private (24.2%), and private (13.7%). Mean operation times were shortest for EE (173.6 ± 72.3min), followed by SSS (188.0 ± 65.4min) and SSH (195.1 ± 61.5min). The median total costs were 26,449€. The SSS group had the lowest median total costs, 2424€ less than SSH and 2095€ less than EE, with no significant differences (p = 0.1657). Significant differences were observed in operating room (OR) costs, with EE being the lowest and SSH the highest (p < 0.0001). Adjusted OR costs in SSH were 23% more than EE and 21% more than SSS. No significant difference was found between EE and SSS OR costs. For mean OR material costs, EE had the lowest, followed by SSS and SSH. Adjusted costs for EE were 52% lower than SSS (p = 0.0005) and 65% lower than SSH (p = 0.0191). Clavien-Dindo Grade ≥ III complication rates were 2.1% for EE, 1.9% for SSH, and 3.0% for SSS. Anastomotic leakage occurred in 12 cases (2.6%), and in-hospital mortality was 0.9% (no deaths in EE; two in SSS and SSH each). EE anastomosis was associated with the lowest OR and material costs in this retrospective analysis while no disadvantages concerning postoperative outcomes could be identified.

Pollution profiles, pathogenicity, and toxicity of bioaerosols in the atmospheric environment of urban general hospital in China.

Airborne microorganisms in hospitals present significant health risks to both patients and employees. However, their pollution profiles and associated hazards in different hospital areas remained largely unknown during the extensive use of masks and disinfectants. This study investigated the characteristics of bioaerosols in an urban general hospital during the COVID-19 pandemic and found that airborne bacteria and fungi concentrations range from 87±35 to 1037±275 CFU/m3 and 21±15 to 561±132 CFU/m3, respectively, with the outpatient clinic and internal medicine ward showing the highest levels. The operating room (OR) and clinical laboratory (LA) had lower bioaerosol levels but higher microbial activities, suggesting that disinfection procedures used to clean bioaerosols may change them into a viable but non-culturable state. The dominant fungi were Cladosporium, Aspergillus, and Penicillium, while the most common viruses were human associated gemykibivirus 2 and human alpha herpesvirus 1. Besides, the dominant pathogens were Staphylococcus aureus, Salmonella enterica, and Pseudomonas aeruginosa. Bacitracin and macrolides resistance genes bacA and ermC were the most prevalent subtypes of antibiotic resistance genes. Compared to the control sample, hospital-acquired bioaerosols, particularly from the outpatient examination room and emergency room can trigger higher levels of inflammatory factors and cell toxicity but lower cell proliferation rates. Lower cell toxicity was observed in low-risk areas (intensive care unit, LA, and OR). This study provides a new method for assessing bioaerosol health risks and enhances understanding of nosocomial and opportunistic infections and their control.

Virtual Reality and Surgical Performance in Operating Room in All Domains: A Systematic Review and Meta-Analysis

Virtual Reality and Surgical Performance in Operating Room in All Domains: A Systematic Review and Meta-Analysis

Concurrent Surgical Care in an Austere Military Setting: A Preparation for Mass Casualty Events.

The U.S. military utilizes small, forward deployed surgical teams to provide Role 2 surgical care in austere environments. These small teams are intended to be able to perform damage control resuscitation and surgery in the event of a mass casualty incident. Our team set out to demonstrate a proof of concept evolution by utilizing 2 operating rooms concurrently with a single certified registered nurse anesthetist and single surgeon to maximize the temporal efficiency of care by performing 4 elective surgical cases staggered in 2 rooms while deployed on an amphibious warship. The surgical component of the Fleet Surgical Team is composed of a single general surgeon, a certified registered nurse anesthetist (acting as an independent practitioner), an operating room registered nurse, a critical care registered nurse, 5 surgical technicians, and 2 general duty corpsmen (consider these individuals roughly equivalent to a licensed practical nurse). Four elective surgical cases were selected to be performed on the USS Wasp while underway on the same date, divided between 2 adjacent operating suites to replicate the logistics of overlapping surgical care required during a mass casualty event. The average surgical care overlap time during the 3 turnover periods was 33 min. The total time saved over the course of the 4 case day, when factoring in both surgical care overlap time and natural turnover time, was 2 h and 33 min. In the setting of multiple injured combat patients, this time saved is enough for an additional damage control trauma operation. When time is the critical factor in preventing both morbidity and mortality, the ability of a deployed surgical team to coordinate concurrent surgical care is of paramount importance. This report can act as a template for future austere surgical teams who encounter multiple simultaneous surgical casualties.

Treatment of both bone forearm fractures with 2.7mm plates: a non-inferiority study.

To determine the effectiveness of 2.7mm plates in treating both bone forearm fractures (BBFFs) compared to the current gold standard of 3.5mm fixation. More specifically, to determine if 2.7mm plates are non-inferior to the current standard of 3.5mm plates. Retrospective including patients from 2016-2021. Single institution, level-1 trauma academic medical center. 77 patients met inclusion criteria, 58 patients underwent fixation with 3.5mm plates and 19 underwent fixation with 2.7mm plates. Plate osteosynthesis with either 2.7mm or 3.5mm plate instrumentation. Maintenance of reduction and achievement of fracture union. Among 77 total patients, 19 received 2.7mm plates and 58 received 3.5mm plates. There was no difference in age and BMI between groups, but the 2.7mm group had fewer males (47% vs 79%, p = 0.02). Primary end points of achievement of union (89.5% vs. 79.3%, p = 0.39) and maintenance of reduction (100% vs. 94.8%, p = 0.99), and secondary end points of implant removal (15.8% vs. 13.8%, p = 0.79), return to the operating room (OR) (5.3% vs. 5.2%, p = 0.63), and minor complications (0% vs. 6.9%, p = 0.99) were similar between the 2.7mm and 3.5mm groups. This study challenges the current standard of ORIF using 3.5mm plates for diaphyseal forearm fractures. 2.7mm plating resulted in at least equivocal achievement of fracture union and thus may be more efficacious given previous studies showing lower refracture risks after implant removal. Level III, retrospective cohort study.

A systematic review of emergency room laparotomy in patients with severe abdominal trauma

Traumatic intra-abdominal hemorrhage contributes to mortality in patients with trauma. However, initiating an emergent laparotomy in the operating room (OR) as a standard treatment can sometimes be time-consuming. To overcome this issue, laparotomy is performed in the emergency room (ER) in some institutions. This systematic review evaluates the efficacy of performing ER laparotomy. Comprehensive searches were conducted in MEDLINE PubMed, EMBASE, and Cochrane databases, up to August 9, 2024. The risk of bias in observational studies was assessed using the ROBINS-I tool. The primary outcome was mortality following ER laparotomy, and the secondary outcome was time from admission to first laparotomy. The review included 10 studies, all of which were observational. A meta-analysis was not performed due to substantial heterogeneity and insufficient data. Mortality rates after ER laparotomy ranged from 23 to 100%. Mortality rates were 23.0–66.7% in the conventional ER group, while they were 0–30% in the OR group. In the hybrid ER group, the 28-day mortality rates were 12.7–15%, compared to 21.7–22% in the conventional group. The time from admission to the first laparotomy was 17–43 min (median) in the conventional ER group, compared to 40–111 min (median) in the OR laparotomy group. In the hybrid ER setting, the time from admission to intervention, including laparotomy, was 35–48 min (median), whereas it was 72–101 min (median) in the conventional group. A high and unclear risk of bias due to confounding was noted across the studies. ER laparotomy may provide rapid bleeding control. However, due to the limited number of studies and significant heterogeneity among the studies reviewed, the true effect size of ER laparotomy in conventional and hybrid ER settings remains unclear.

Patient Falls in the Operating Room: The Danger of an Obese Patient on an Unlocked Operating Room Table.

Patient Falls in the Operating Room: The Danger of an Obese Patient on an Unlocked Operating Room Table.

Practice and factors affecting informed consent among healthcare workers for major surgical procedures at Gurage zone hospitals, South Ethiopia, 2022: a facility-based cross-sectional study

ObjectiveThis study aimed to assess the informed consent practice process and associated factors among healthcare workers for major surgical procedures at Gurage zone hospitals, in 2022.Methods and materialsInstitution-based cross-sectional study...

Extracorporeal membrane oxygenation is associated with decreased mortality in non-acute respiratory distress syndrome patients following severe blunt thoracic trauma.

Extracorporeal membrane oxygenation (ECMO) has emerged as a critical intervention in the management of patients with trauma-induced cardiorespiratory failure. This study aims to compare outcomes in patients with severe thoracic injuries with and without venovenous extracorporeal membrane oxygenation (VV-ECMO). We performed a retrospective cohort study on Trauma Quality Improvement Program (2017-2021) and included all patients with isolated blunt thoracic injuries with Abbreviated Injury Scale score of ≥4 who required intubation. Patients were divided into two groups based on VV-ECMO and were compared using propensity score matching with the primary outcome of mortality. A total of 14,106 patients with severe thoracic injuries were identified. Propensity score matching resulted in two groups of 812 VV-ECMO and 812 non-VV-ECMO groups. Venovenous ECMO group had significantly lower in-hospital mortality rates (22.3% vs. 37.3%, p < 0.001). However, VV-ECMO group had significantly higher rates of complications including cardiac arrest (27.7% vs. 10.6%), pulmonary embolism (7.6% vs. 2.1%), ventilator-associated pneumonia (16.7% vs. 4.2%), unplanned intubation (11.9% vs. 8.5%), unplanned intensive care unit (ICU) admission (8.4% vs. 4.9%), and unplanned return to operation room (10.1% vs. 2.6%) (p < 0.001, for all). Patients in VV-ECMO group had significantly higher hospital (29.46 ± 26.37 vs. 13.59 ± 13.3 days) and ICU (22.96 ± 19.38 vs. 9.38 ± 9.05 days) length of stay (p < 0.001, for both). In VV-ECMO group, the mean ± SD time to perform VV-ECMO was 5.54 ± 5.91 days. Each day earlier initiation of VV-ECMO resulted in decreased hospital and ICU length of stay by 67.1% and 59.9%, respectively (p < 0.001 for both). Among patients without acute respiratory distress syndrome (n = 435 in each group after repeated PS matching), we observed significantly lower mortality rates in VV-ECMO group (26.9% vs. 40%, p < 0.001). While VV-ECMO in isolated blunt thoracic trauma patients is associated with higher survival rates even in non-acute respiratory distress syndrome cases, it is associated with higher incidence of complications. These findings emphasize earlier consideration of VV-ECMO in severe blunt thoracic trauma. Retrospective Study; Level III.

Multicenter audit of operating room staff compliance with the surgical safety checklist: a cross-sectional study from a low- and middle-income country

BackgroundUnsafe surgical practices are a preventable cause of morbidity and mortality. The WHO published its surgical safety checklist (SSC) to help reduce surgical errors and complications and improve patient outcomes. This study aims to audit compliance with the WHO’s SSC and explore attitudes toward its implementation in hospitals within a low- and middle-income country.MethodsThis was a two-part, cross-sectional study in which a retrospective desk review was used to audit compliance with SSC use, and a questionnaire was used to explore attitudes toward the SSC. The data were collected between September and November 2021 from two major governmental and nongovernmental hospitals. Surgeons, anesthesiologists, and surgical nurses were invited to complete a self-administered questionnaire that measured attitudes across five domains via a 5-point Likert scale.ResultsThe final sample consisted of 340 patients whose records were retrieved from one governmental hospital (n=170) and one nongovernmental hospital (n=170). Among those patients, 93 (27.4%) underwent general surgery, 49 (14.4%) underwent orthopedic surgery, and 45 (13.2%) underwent pediatric surgery. The SSCs were fully completed for 27.9% of the patients, partially completed for 43.2% of the patients, and left blank for 28.8% of the patients. Compliance with the use of the SSC was significantly associated with age (p=0.002), sex (p=0.022), type of surgery (p<0.001), classification of surgery (p=0.006) and hospital sector (p<0.001). None of the patients at the governmental hospital had a completely filled the SSC, whereas none of those at the nongovernmental hospital had a blank SSC. Among the final sample of 80 operating room staff members included in the study that explored their attitudes, 41.3%, 40.0%, and 18.8% were surgeons, surgical nurses, and anesthesiologists, respectively. The participants demonstrated positive attitudes toward the SSC across all the attitude domains. The majority said that lack of time (56.3%), staff assertiveness (55.0%), and training (53.8%) were the most important barriers to implementing the SSC. The hospital sector was significantly associated with higher scores across all domains.ConclusionsWhile the majority of operating room staff used the SSC, only a minority filled the list completely. The attitudes toward using the WHO’s SSC trended positively, which encourages the official implementation of the SSC at the national level. Addressing the identified barriers may enhance the quality of implementation by providing educational sessions. Future reaudits are recommended to enhance the adaptability of the SSC.

Analyzing and mitigating the risks of patient harm during operating room to intensive care unit patient handoffs.

Patients continue to suffer from preventable harm and uneven quality outcomes. Reliable clinical outcomes depend on the quality of robust administrative systems and reliable support processes. Critically ill patient handoffs from the operating room (OR) to the intensive care unit (ICU) are known to be high-risk events. We describe a novel perspective on how risk factors associated with the process of patient handoff communication between the OR and the ICU can lead to flawed communication, degraded team awareness, medical errors, and increased patient harm. Data were collected from two semi-structured focus groups using a five-step risk management approach at a tertiary hospital in São Paulo, Brazil. We conducted a failure modes and effects analysis (FMEA) with multidisciplinary healthcare providers consisting of attending physicians, anesthesiologists, nurses, and physiotherapists involved in patient handoffs. We analyzed the results using a similitude analysis to evaluate the effectiveness of implementing this novel risk management approach. We identified the handoffs risks associated with patients, staff, institution, and potential financial risks. The FMEA identified 12 process failures and 36 causes that generated 12 consequences and pointed to robust needed preventive measures to mitigate handoff risks. The clinical teams reported that this approach allowed them to see the process more completely as a whole not only in their narrow silos, thus understanding the enablers and difficulties of the other team members and how this understanding can shed light on their mental models, actions, and the process reliability. Teams identified key steps in the OR to ICU handoff process that are prone to the highest hazards to patients, the hospital, and staff, and are currently targeted for process improvement. Evidence-driven recommendations intended for reducing the risks associated with patient handoffs are presented. Implementing a dynamic risk management, interdisciplinary approach was used to redesign the OR to ICU patient handoff approach around the patient's and clinician's needs. The risk management program helped healthcare providers identify handoff steps, highlighting risky handoff process failures, making it possible to identify actionable failures, consequences, and define preventative action plans for mitigating the risks to improve the quality and safety of patient handoffs.

A multi-tissue longitudinal proteomics study to evaluate the suitability of post-mortem samples for pathophysiological research

Recent developments in mass spectrometry-based proteomics have established it as a robust tool for system-wide analyses essential for pathophysiological research. While post-mortem samples are a critical source for these studies, our understanding of how body decomposition influences the proteome remains limited. Here, we have revisited published data and conducted a clinically relevant time-course experiment in mice, revealing organ-specific proteome regulation after death, with only a fraction of these changes linked to protein autolysis. The liver and spleen exhibit significant proteomic alterations within hours post-mortem, whereas the heart displays only modest changes. Additionally, subcellular compartmentalization leads to an unexpected surge in proteome alterations at the earliest post-mortem interval (PMI). Additionally, we have conducted a comprehensive analysis of semi-tryptic peptides, revealing distinct consensus motifs for different organs, indicating organ-specific post-mortem protease activity. In conclusion, our findings emphasize the critical importance of considering PMI effects when designing proteomics studies, as these effects may significantly overshadow the impacts of diseases. Preferably, the samples should be taken in the operation room, especially for studies including subcellular compartmentalization or trans-organ comparison. In single-organ studies, the planning should involve careful control of PMI.

A Comparison of Complication Rates in Flexor Tendon Repair Performed in Operating Rooms Versus Clinic-Based Procedure Rooms

A Comparison of Complication Rates in Flexor Tendon Repair Performed in Operating Rooms Versus Clinic-Based Procedure Rooms

Numerical study on the application of low-turbulence air curtain surrounding laminar airflow distribution in operating rooms

Abstract Laminar airflow (LAF) is essential for maintaining a sterile environment in operating rooms, but its rapid unidirectional flow decay leads to low airflow efficiency and increases energy consumption. The objective of this study is to investigate the energy-saving and air quality benefits of using a low-turbulence air curtain around laminar airflow, which is referred to as protective laminar airflow (PLAF). Numerical simulations were used to model airflow and particle transport, and a series of experiments were conducted in a real operating room at St. Olavs Hospital, Norway, to validate the simulation results. The findings indicate that when the unidirectional airflow supply velocity is maintained at 0.25 m/s, combined with an air curtain that has the width of 2 cm and the velocity of 1.5 m/s, the PLAF system outperforms the conventional LAF system operating at a unidirectional airflow supply velocity of 0.30 m/s. This configuration results in a 17.3% energy saving, showing the potential of this airflow distribution strategy to enhance both cleanliness and energy efficiency.

Laparoscopic Nissen fundoplication is more cost-effective than open Nissen fundoplication in children

BackgroundNissen fundoplication is one of the most common surgical procedures for gastroesophageal reflux. Current and previous research comparing laparoscopic Nissen fundoplication (LNF) versus open Nissen fundoplication (ONF) in children suggest ambiguous conclusions. The purpose of this retrospective study was to compare the outcome for children operated with LNF or ONF at our institution and to evaluate the economic aspects.Methods32 consecutive patients (LNF: n = 18, ONF: n = 14) operated with Nissen fundoplication between the years 2011–2017 were included in the study. Data was collected by examination of the patient journals and preoperative, operative, postoperative, and post-discharge parameters were analyzed.ResultsCompared to ONF, the LNF group had shorter operating time (165.2 vs 216.6 min, p < 0.05), shorter overall operating room duration (315.0 vs 334.9 min, p < 0.05) and shorter postoperative hospital stay (3.8 vs 8.1 days, p < 0.05). The LNF group also required less morphine (1.2 vs 1.7 mg/kg, p < 0.05) and the total cost per case was 39% lower (261.1 vs 427.4 kSEK, p < 0.05). No difference was seen in postoperative complications and results.ConclusionLaparoscopic Nissen fundoplication is more cost-effective compared to open surgery and reduces postoperative hospital stay and morphine requirements.

Adherence to Radiation Protection Principles in the Clinical Environment among Anesthesia and Operating Room Nursing Students: Implications for Educational Interventions

Adherence to Radiation Protection Principles in the Clinical Environment among Anesthesia and Operating Room Nursing Students: Implications for Educational Interventions

Video-based propagation of tacit knowledge during coil embolization of intracranial aneurysms.

Neuroendovascular treatment of cerebral aneurysms is considered a basic procedure for neurosurgeons and interventional neuroradiologists; however, its critical technical nuances, termed "tacit knowledge," are challenging to impart. This study aimed to evaluate the efficacy of our novel video recording and editing method in enhancing trainees' experience. A wearable camera (wearable recording) and multiple media sources in a hybrid operating room (hybrid recording) were used to capture procedural details such as audio and conversation, thus enabling a re-experience. Trainees condensed both recordings into summary videos and a supervisor subsequently evaluated them. Six trainees watched the following three videos: Video 1, only hybrid recording; Video 2, only wearable recording; and Video 3, both wearable and hybrid recordings synchronized, and then provided semi-quantitative evaluations ranging from 0 (not useful at all) to 5 (extremely useful). We examined 64 unruptured cerebral aneurysm coil embolizations using hybrid wearable recording methods. Video 3 received the highest rating among all participants (5±0 [mean ± standard deviation]), while Videos 1 and 2 received relatively lower ratings (Video 1:3.8±0.7; Video 2:4.2±0.4). The educational impact of video editing across all videos was rated highly (4.4±0.8). The respondents showed diverse opinions on editing time, with some perceiving it as less time-consuming than other surgery video edits (3.4±1.1). Our hybrid and wearable recording and editing methods facilitated the propagation of tacit knowledge of coil embolization and enhanced surgical education by enabling more efficient learning of technical tips.

Time-driven cost analysis of pediatric liver biopsy completed in pediatric sedation clinic and operating room.

Pediatric ultrasound (US)-guided percutaneous liver biopsy is a commonly performed procedure in children, and may be performed in a variety of clinical settings. However, there is little research on the relative costs associated with different sedation methods and locations. This study uses time-driven activity-based costing (TDABC) to identify relevant costs associated with different biopsy sedation techniques and locations to help inform providers and patients as well as guide value-conscious care. This study analyzes the direct costs associated with pediatric liver biopsy performed in an OR versus a dedicated pediatric sedation clinic. A single-center retrospective review including data from consecutive procedures all completed by one board-certified interventional radiology physician between June 2021 and April 2024 was performed. Exclusion criteria included procedures with lack of timestamps (N = 3), and multiple procedures being completed causing a deviation from the standard pathway process (N = 19). Direct costs were calculated using cost capacity rates (CCR) and TDABC methodology. Propensity score matching between procedures performed in a sedation clinic versus an operating room (OR) was performed adjusting for age, gender, American Society of Anesthesiologists (ASA) status, and inpatient status, and subsequent matches were analyzed via paired t-test in SPSS. A total of 111 procedures performed in the OR (N = 71) or sedation clinic (N = 40) were found and considered for analysis (N = 55 male, N = 56 female; mean age = 9.13, SD = 6.69years). A technical success rate of 100% and a complication frequency of 5% (N = 3, mean = 13.67, SD = 2.05, all grade 1) were observed. Complication frequency was not statistically significant between the sedation clinic (N = 1) and OR (N = 2) groups (P = 0.28). After propensity matching, N = 58 matched procedures (OR, N = 29; sedation clinic, N = 29) were included. Pre-procedure times in the sedation clinic were shorter in duration (62.11 ± 42.25) than in the OR (111.96 ± 62.11, P < 0.001). Total procedure times were also shorter in duration in the sedation clinic (14.07 ± 4.99) than in the OR (21.76 ± 18.22, P = 0.03). In addition, procedures completed in the OR utilized additional anesthesia staff for an average of 72min, contributing to overall cost. The average total included costs for matched liver biopsy procedures were $1,089.51 ± 384.34 in the sedation clinic and $2,801.36 ± 1,201.52 in the OR (P < 0.001). Liver biopsies completed in the sedation clinic were associated with significantly lower direct costs and were not associated with higher complication rates. These findings provide evidence for promoting pediatric sedation clinics as a safe and cost-effective location to perform liver biopsies in appropriate patients.