A regional anesthesia-based ‘‘swing’’ operating room model reduces non-operative time in a mixed orthopedic inpatient/ outpatient population Un modèle de salle « en rotation » basée sur l’anesthésie régionale en orthopédie réduit le temps non-opératoire dans une population mixte de patients ambulatoires et hospitalisés

Purpose 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. Methods 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. Results 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. Conclusion 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. Resume Objectif Nous avons recemment parle de l’efficacite pour l’augmentation du nombre de cas traites d’un nouveau modele de salle « en rotation » impliquant l’utilisation en alternance de deux salles d’operation et l’utilisation de l’anesthesie regionale dans un centre specialise en chirurgie orthopedique ambulatoire. L’objectif de cette etude etait d’evaluer ce modele dans le cadre d’un ensemble de salles d’operations accueillant aussi bien des patients hospitalises que des patients ambulatoires. Author contributions Paul Mercereau performed the data abstraction, was involved in the statistical analysis, and wrote the first draft of the manuscript. Bobby Lee and Stephan K.W. Schwarz were involved in data interpretation. Bobby Lee, Stephen J. Head, and Stephan K.W. Schwarz were involved in the concept and design of the study. Bobby Lee and Stephen J. Head were involved in manuscript editing. Stephan K.W. Schwarz was involved in data analysis, and he critically revised the manuscript. P. Mercereau, MD B. Lee, MD S. J. Head, MD S. K. W. Schwarz, MD, PhD Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada P. Mercereau, MD B. Lee, MD S. J. Head, MD S. K. W. Schwarz, MD, PhD (&) Department of Anesthesia, St. Paul’s Hospital, Providence Level 3, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada e-mail: stephan.schwarz@ubc.ca 123 Can J Anesth/J Can Anesth (2012) 59:943–949 DOI 10.1007/s12630-012-9765-x