Impact of COVID-19 pandemic-induced surgical restrictions on operational performance: a case study at the University Hospital of Ulm
Introduction The operating room (OR) is a high-cost and high-revenue area in a hospital comprising extremely complex process steps to treat patients. The perioperative process quality can be optimized through an efficiency-oriented central OR management based on performance indices. However, during...
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| Veröffentlicht in: | European journal of trauma and emergency surgery (Munich : 2007) 2024-10, Vol.50 (5), p.2411-2420 |
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| creator | Datzmann, Thomas Dörfer, Lena Freude, Gregor Hannemann, Michael Tharmaratnam, Gayathiri Stangl, Philipp Swoboda, Walter Schafmeister, Sylvia Gebhard, Florian Kaisers, Udo X. Huber-Lang, Markus |
| description | Introduction
The operating room (OR) is a high-cost and high-revenue area in a hospital comprising extremely complex process steps to treat patients. The perioperative process quality can be optimized through an efficiency-oriented central OR management based on performance indices. However, during the COVID-19 pandemic with the corresponding OR restrictions, there was a significant nation- and worldwide decline in the performance, which may have a lasting impact. Therefore, we proposed the hypothesis that COVID-19 pandemic-related OR restrictions could reduce operative performance in the long term.
Methods
A retrospective, descriptive analysis of perioperative processing times was conducted exemplarily at the University Hospital Ulm using a pre-post design, examining the corresponding second quarters of 2019 to 2022. In total, n = 18,489 operations with n = 314,313 individual time intervals were analyzed. The statistical analyses included the Kruskal–Wallis test adjusted for multiple testing, and the significance level was set at
p
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| doi_str_mv | 10.1007/s00068-024-02558-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11599351</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3133048184</sourcerecordid><originalsourceid>FETCH-LOGICAL-c356t-d5e73cc99e835748d7f0ef2d014b8344483ac48eddfcc896a9240482a461ed573</originalsourceid><addsrcrecordid>eNp9kT1vFDEQhi0EIiHwByiQJRqaDfb6Y700CB2QnBQpDUdrOfbsxdGuvdjeSJeaH47DheOjoLA81jzzznhehF5SckoJ6d5mQohUDWl5PUKo5u4ROqZKsqbvOX18iBk7Qs9yvqk0kaJ9io6YUrIXlB6j7-tpNrbgOODV5df1x4b2eDbBweRt44NbLDicl7T11ow4QS7J2-JjyDgGHGdI5v5VczUcYppMsPAOG2xNBpzL4nbYFFyuAW-Cv4WUfdnh85hnX2pRbbsZp-foyWDGDC8e7hO0-fzpy-q8ubg8W68-XDSWCVkaJ6Bj1vY9KCY6rlw3EBhaRyi_UoxzrpixXIFzg7Wql6ZvOeGqNVxScKJjJ-j9XnderiZwFkJJZtRz8pNJOx2N139ngr_W23irKRV1jYJWhTcPCil-W-o29OSzhXE0AeKSNSOy6ykXklT09T_oTVxS3VSlKGN1MKp4pdo9ZVPMOcFwmIYSfe-y3rusq8v6p8v6rha9-vMfh5JftlaA7YFcU2EL6Xfv_8j-AIt3tQc</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3133048184</pqid></control><display><type>article</type><title>Impact of COVID-19 pandemic-induced surgical restrictions on operational performance: a case study at the University Hospital of Ulm</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Datzmann, Thomas ; Dörfer, Lena ; Freude, Gregor ; Hannemann, Michael ; Tharmaratnam, Gayathiri ; Stangl, Philipp ; Swoboda, Walter ; Schafmeister, Sylvia ; Gebhard, Florian ; Kaisers, Udo X. ; Huber-Lang, Markus</creator><creatorcontrib>Datzmann, Thomas ; Dörfer, Lena ; Freude, Gregor ; Hannemann, Michael ; Tharmaratnam, Gayathiri ; Stangl, Philipp ; Swoboda, Walter ; Schafmeister, Sylvia ; Gebhard, Florian ; Kaisers, Udo X. ; Huber-Lang, Markus</creatorcontrib><description>Introduction
The operating room (OR) is a high-cost and high-revenue area in a hospital comprising extremely complex process steps to treat patients. The perioperative process quality can be optimized through an efficiency-oriented central OR management based on performance indices. However, during the COVID-19 pandemic with the corresponding OR restrictions, there was a significant nation- and worldwide decline in the performance, which may have a lasting impact. Therefore, we proposed the hypothesis that COVID-19 pandemic-related OR restrictions could reduce operative performance in the long term.
Methods
A retrospective, descriptive analysis of perioperative processing times was conducted exemplarily at the University Hospital Ulm using a pre-post design, examining the corresponding second quarters of 2019 to 2022. In total, n = 18,489 operations with n = 314,313 individual time intervals were analyzed. The statistical analyses included the Kruskal–Wallis test adjusted for multiple testing, and the significance level was set at
p
< 0.01.
Results
The results revealed not only a significant decrease in the case volume by 31% (2020) and 23% (2021) during the COVID-19 crisis years, but also significant time delays in various process steps; e.g. the median patient’s OR occupancy time (column time) rose from 65 min (2019) to 87 min (2020) and remained elevated (72 min in 2021 and 74 min in 2022, respectively). Even in 2022, beyond the pandemic, the net anaesthesia time was permanently enhanced by 9 min per case. Furthermore, both, the incision-to-closure time and surgeon attachment time were each significantly prolonged by 7 additional minutes, and the time from the end of anaesthesia to the release of the next patient was extended by 4 min. Selected standardized index operations showed only a trend towards these changes, even with a decrease in the incision-to-closure time over time.
Conclusion
Overall, long-term changes were found in essential perioperative process times even after retraction of the COVID-19 restrictions, indicating some processual “slow down” after the Covid-19-induced “shut down”. Further analyses are needed to determine the appropriate targeted control measures to improve processing times and increase the process quality.</description><identifier>ISSN: 1863-9933</identifier><identifier>ISSN: 1863-9941</identifier><identifier>EISSN: 1863-9941</identifier><identifier>DOI: 10.1007/s00068-024-02558-z</identifier><identifier>PMID: 38869511</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>COVID-19 ; COVID-19 - epidemiology ; COVID-19 - prevention & control ; Critical Care Medicine ; Emergency Medicine ; Germany - epidemiology ; Hospitals, University ; Humans ; Intensive ; Medicine ; Medicine & Public Health ; Operating Rooms ; Operative Time ; Original ; Original Article ; Pandemics ; Retrospective Studies ; SARS-CoV-2 ; Sports Medicine ; Surgery ; Surgical Orthopedics ; Surgical Procedures, Operative ; Traumatic Surgery</subject><ispartof>European journal of trauma and emergency surgery (Munich : 2007), 2024-10, Vol.50 (5), p.2411-2420</ispartof><rights>The Author(s) 2024</rights><rights>2024. The Author(s).</rights><rights>The Author(s) 2024. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2024 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c356t-d5e73cc99e835748d7f0ef2d014b8344483ac48eddfcc896a9240482a461ed573</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00068-024-02558-z$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00068-024-02558-z$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38869511$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Datzmann, Thomas</creatorcontrib><creatorcontrib>Dörfer, Lena</creatorcontrib><creatorcontrib>Freude, Gregor</creatorcontrib><creatorcontrib>Hannemann, Michael</creatorcontrib><creatorcontrib>Tharmaratnam, Gayathiri</creatorcontrib><creatorcontrib>Stangl, Philipp</creatorcontrib><creatorcontrib>Swoboda, Walter</creatorcontrib><creatorcontrib>Schafmeister, Sylvia</creatorcontrib><creatorcontrib>Gebhard, Florian</creatorcontrib><creatorcontrib>Kaisers, Udo X.</creatorcontrib><creatorcontrib>Huber-Lang, Markus</creatorcontrib><title>Impact of COVID-19 pandemic-induced surgical restrictions on operational performance: a case study at the University Hospital of Ulm</title><title>European journal of trauma and emergency surgery (Munich : 2007)</title><addtitle>Eur J Trauma Emerg Surg</addtitle><addtitle>Eur J Trauma Emerg Surg</addtitle><description>Introduction
The operating room (OR) is a high-cost and high-revenue area in a hospital comprising extremely complex process steps to treat patients. The perioperative process quality can be optimized through an efficiency-oriented central OR management based on performance indices. However, during the COVID-19 pandemic with the corresponding OR restrictions, there was a significant nation- and worldwide decline in the performance, which may have a lasting impact. Therefore, we proposed the hypothesis that COVID-19 pandemic-related OR restrictions could reduce operative performance in the long term.
Methods
A retrospective, descriptive analysis of perioperative processing times was conducted exemplarily at the University Hospital Ulm using a pre-post design, examining the corresponding second quarters of 2019 to 2022. In total, n = 18,489 operations with n = 314,313 individual time intervals were analyzed. The statistical analyses included the Kruskal–Wallis test adjusted for multiple testing, and the significance level was set at
p
< 0.01.
Results
The results revealed not only a significant decrease in the case volume by 31% (2020) and 23% (2021) during the COVID-19 crisis years, but also significant time delays in various process steps; e.g. the median patient’s OR occupancy time (column time) rose from 65 min (2019) to 87 min (2020) and remained elevated (72 min in 2021 and 74 min in 2022, respectively). Even in 2022, beyond the pandemic, the net anaesthesia time was permanently enhanced by 9 min per case. Furthermore, both, the incision-to-closure time and surgeon attachment time were each significantly prolonged by 7 additional minutes, and the time from the end of anaesthesia to the release of the next patient was extended by 4 min. Selected standardized index operations showed only a trend towards these changes, even with a decrease in the incision-to-closure time over time.
Conclusion
Overall, long-term changes were found in essential perioperative process times even after retraction of the COVID-19 restrictions, indicating some processual “slow down” after the Covid-19-induced “shut down”. Further analyses are needed to determine the appropriate targeted control measures to improve processing times and increase the process quality.</description><subject>COVID-19</subject><subject>COVID-19 - epidemiology</subject><subject>COVID-19 - prevention & control</subject><subject>Critical Care Medicine</subject><subject>Emergency Medicine</subject><subject>Germany - epidemiology</subject><subject>Hospitals, University</subject><subject>Humans</subject><subject>Intensive</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Operating Rooms</subject><subject>Operative Time</subject><subject>Original</subject><subject>Original Article</subject><subject>Pandemics</subject><subject>Retrospective Studies</subject><subject>SARS-CoV-2</subject><subject>Sports Medicine</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Surgical Procedures, Operative</subject><subject>Traumatic Surgery</subject><issn>1863-9933</issn><issn>1863-9941</issn><issn>1863-9941</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><recordid>eNp9kT1vFDEQhi0EIiHwByiQJRqaDfb6Y700CB2QnBQpDUdrOfbsxdGuvdjeSJeaH47DheOjoLA81jzzznhehF5SckoJ6d5mQohUDWl5PUKo5u4ROqZKsqbvOX18iBk7Qs9yvqk0kaJ9io6YUrIXlB6j7-tpNrbgOODV5df1x4b2eDbBweRt44NbLDicl7T11ow4QS7J2-JjyDgGHGdI5v5VczUcYppMsPAOG2xNBpzL4nbYFFyuAW-Cv4WUfdnh85hnX2pRbbsZp-foyWDGDC8e7hO0-fzpy-q8ubg8W68-XDSWCVkaJ6Bj1vY9KCY6rlw3EBhaRyi_UoxzrpixXIFzg7Wql6ZvOeGqNVxScKJjJ-j9XnderiZwFkJJZtRz8pNJOx2N139ngr_W23irKRV1jYJWhTcPCil-W-o29OSzhXE0AeKSNSOy6ykXklT09T_oTVxS3VSlKGN1MKp4pdo9ZVPMOcFwmIYSfe-y3rusq8v6p8v6rha9-vMfh5JftlaA7YFcU2EL6Xfv_8j-AIt3tQc</recordid><startdate>20241001</startdate><enddate>20241001</enddate><creator>Datzmann, Thomas</creator><creator>Dörfer, Lena</creator><creator>Freude, Gregor</creator><creator>Hannemann, Michael</creator><creator>Tharmaratnam, Gayathiri</creator><creator>Stangl, Philipp</creator><creator>Swoboda, Walter</creator><creator>Schafmeister, Sylvia</creator><creator>Gebhard, Florian</creator><creator>Kaisers, Udo X.</creator><creator>Huber-Lang, Markus</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20241001</creationdate><title>Impact of COVID-19 pandemic-induced surgical restrictions on operational performance: a case study at the University Hospital of Ulm</title><author>Datzmann, Thomas ; Dörfer, Lena ; Freude, Gregor ; Hannemann, Michael ; Tharmaratnam, Gayathiri ; Stangl, Philipp ; Swoboda, Walter ; Schafmeister, Sylvia ; Gebhard, Florian ; Kaisers, Udo X. ; Huber-Lang, Markus</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-d5e73cc99e835748d7f0ef2d014b8344483ac48eddfcc896a9240482a461ed573</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>COVID-19</topic><topic>COVID-19 - epidemiology</topic><topic>COVID-19 - prevention & control</topic><topic>Critical Care Medicine</topic><topic>Emergency Medicine</topic><topic>Germany - epidemiology</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>Intensive</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Operating Rooms</topic><topic>Operative Time</topic><topic>Original</topic><topic>Original Article</topic><topic>Pandemics</topic><topic>Retrospective Studies</topic><topic>SARS-CoV-2</topic><topic>Sports Medicine</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Surgical Procedures, Operative</topic><topic>Traumatic Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Datzmann, Thomas</creatorcontrib><creatorcontrib>Dörfer, Lena</creatorcontrib><creatorcontrib>Freude, Gregor</creatorcontrib><creatorcontrib>Hannemann, Michael</creatorcontrib><creatorcontrib>Tharmaratnam, Gayathiri</creatorcontrib><creatorcontrib>Stangl, Philipp</creatorcontrib><creatorcontrib>Swoboda, Walter</creatorcontrib><creatorcontrib>Schafmeister, Sylvia</creatorcontrib><creatorcontrib>Gebhard, Florian</creatorcontrib><creatorcontrib>Kaisers, Udo X.</creatorcontrib><creatorcontrib>Huber-Lang, Markus</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Datzmann, Thomas</au><au>Dörfer, Lena</au><au>Freude, Gregor</au><au>Hannemann, Michael</au><au>Tharmaratnam, Gayathiri</au><au>Stangl, Philipp</au><au>Swoboda, Walter</au><au>Schafmeister, Sylvia</au><au>Gebhard, Florian</au><au>Kaisers, Udo X.</au><au>Huber-Lang, Markus</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of COVID-19 pandemic-induced surgical restrictions on operational performance: a case study at the University Hospital of Ulm</atitle><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle><stitle>Eur J Trauma Emerg Surg</stitle><addtitle>Eur J Trauma Emerg Surg</addtitle><date>2024-10-01</date><risdate>2024</risdate><volume>50</volume><issue>5</issue><spage>2411</spage><epage>2420</epage><pages>2411-2420</pages><issn>1863-9933</issn><issn>1863-9941</issn><eissn>1863-9941</eissn><abstract>Introduction
The operating room (OR) is a high-cost and high-revenue area in a hospital comprising extremely complex process steps to treat patients. The perioperative process quality can be optimized through an efficiency-oriented central OR management based on performance indices. However, during the COVID-19 pandemic with the corresponding OR restrictions, there was a significant nation- and worldwide decline in the performance, which may have a lasting impact. Therefore, we proposed the hypothesis that COVID-19 pandemic-related OR restrictions could reduce operative performance in the long term.
Methods
A retrospective, descriptive analysis of perioperative processing times was conducted exemplarily at the University Hospital Ulm using a pre-post design, examining the corresponding second quarters of 2019 to 2022. In total, n = 18,489 operations with n = 314,313 individual time intervals were analyzed. The statistical analyses included the Kruskal–Wallis test adjusted for multiple testing, and the significance level was set at
p
< 0.01.
Results
The results revealed not only a significant decrease in the case volume by 31% (2020) and 23% (2021) during the COVID-19 crisis years, but also significant time delays in various process steps; e.g. the median patient’s OR occupancy time (column time) rose from 65 min (2019) to 87 min (2020) and remained elevated (72 min in 2021 and 74 min in 2022, respectively). Even in 2022, beyond the pandemic, the net anaesthesia time was permanently enhanced by 9 min per case. Furthermore, both, the incision-to-closure time and surgeon attachment time were each significantly prolonged by 7 additional minutes, and the time from the end of anaesthesia to the release of the next patient was extended by 4 min. Selected standardized index operations showed only a trend towards these changes, even with a decrease in the incision-to-closure time over time.
Conclusion
Overall, long-term changes were found in essential perioperative process times even after retraction of the COVID-19 restrictions, indicating some processual “slow down” after the Covid-19-induced “shut down”. Further analyses are needed to determine the appropriate targeted control measures to improve processing times and increase the process quality.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>38869511</pmid><doi>10.1007/s00068-024-02558-z</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | COVID-19 COVID-19 - epidemiology COVID-19 - prevention & control Critical Care Medicine Emergency Medicine Germany - epidemiology Hospitals, University Humans Intensive Medicine Medicine & Public Health Operating Rooms Operative Time Original Original Article Pandemics Retrospective Studies SARS-CoV-2 Sports Medicine Surgery Surgical Orthopedics Surgical Procedures, Operative Traumatic Surgery |
| title | Impact of COVID-19 pandemic-induced surgical restrictions on operational performance: a case study at the University Hospital of Ulm |
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