Predictors of anesthesia ready time: Analysis and benchmark dataCentral MessagePerspective
Objective: Patients undergoing congenital cardiac surgery require induction of anesthesia. Our objective was to identify the median anesthesia ready time and the predictors of this time. Methods: By using the Society of Thoracic Surgeons Congenital Heart Surgery Database, we identified patients who...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-09-01
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| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273623001778 |
| _version_ | 1797674173080797184 |
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| author | Morgan L. Brown, MD, PhD Steven J. Staffa, MS Luis G. Quinonez, MD James A. DiNardo, MD Viviane G. Nasr, MD, MPH |
| author_facet | Morgan L. Brown, MD, PhD Steven J. Staffa, MS Luis G. Quinonez, MD James A. DiNardo, MD Viviane G. Nasr, MD, MPH |
| author_sort | Morgan L. Brown, MD, PhD |
| collection | DOAJ |
| description | Objective: Patients undergoing congenital cardiac surgery require induction of anesthesia. Our objective was to identify the median anesthesia ready time and the predictors of this time. Methods: By using the Society of Thoracic Surgeons Congenital Heart Surgery Database, we identified patients who underwent cardiopulmonary bypass procedures from 2017 to 2021. Univariate and multivariable regression modeling to predict the anesthesia ready time was performed using mixed-effects linear regression. Results: After exclusion of outliers, 44,418 cases were analyzed. The median anesthesia ready time was 51 minutes (interquartile range, 38-66). On multivariable analysis, independent predictors of a longer anesthesia ready time included decreasing weight (0.3 min/10 kg, 95% CI, 0.1-0.6; P = .011), prematurity (1.5 minutes, 95% CI, 0.8-2.2; P < .001), and presence of chromosomal abnormality (3.4 minutes, 95% CI, 1.5-5.2; P < .001). An increase in the duration in anesthesia ready time was seen with increasing Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery mortality category with an additional 7.8 minutes (95% CI, 5.2-10.4; P < .001) for a Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery 5 procedure compared with Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery 1. Emergency versus elective case designation was associated with an anesthesia ready time reduction of 3.6 minutes (95% CI, 1.1-6.1; P = .005), and an afternoon case start was associated with an anesthesia ready time reduction of 4.2 minutes (95% CI, 2.8-5.6; P < .001). The presence of an anesthesia trainee increased the anesthesia ready time by 3.8 minutes (95% CI, 2.6-5.0; P < .001). The presence of an airway in situ decreased the anesthesia ready time by 3.6 minutes (95% CI, 1.6-5.5; P < .001), whereas an in situ arterial line decreased the anesthesia ready time by 7.4 minutes (95% CI, 4.6-10.2; P < .001). Placement of a central venous line increased the anesthesia ready time by 8.5 minutes (95% CI, 5.9-11.1; P < .001). Conclusions: The median anesthesia ready time was 51 minutes. For patients with characteristics associated with prolonged anesthesia ready time, consideration should be given to allocation of additional anesthesia staffing to improve efficiency. |
| first_indexed | 2024-03-11T21:55:14Z |
| format | Article |
| id | doaj.art-e557e2e574b14b87b11b0331df80a380 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-03-11T21:55:14Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-e557e2e574b14b87b11b0331df80a3802023-09-26T04:12:34ZengElsevierJTCVS Open2666-27362023-09-0115446453Predictors of anesthesia ready time: Analysis and benchmark dataCentral MessagePerspectiveMorgan L. Brown, MD, PhD0Steven J. Staffa, MS1Luis G. Quinonez, MD2James A. DiNardo, MD3Viviane G. Nasr, MD, MPH4Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Mass; Address for reprints: Morgan L. Brown, MD, PhD, Bader 3, 300 Longwood Ave, Boston MA 02115.Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MassDivision of Cardiac Surgery, Boston Children's Hospital, Boston, MassDivision of Cardiac Anesthesia, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MassDivision of Cardiac Anesthesia, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MassObjective: Patients undergoing congenital cardiac surgery require induction of anesthesia. Our objective was to identify the median anesthesia ready time and the predictors of this time. Methods: By using the Society of Thoracic Surgeons Congenital Heart Surgery Database, we identified patients who underwent cardiopulmonary bypass procedures from 2017 to 2021. Univariate and multivariable regression modeling to predict the anesthesia ready time was performed using mixed-effects linear regression. Results: After exclusion of outliers, 44,418 cases were analyzed. The median anesthesia ready time was 51 minutes (interquartile range, 38-66). On multivariable analysis, independent predictors of a longer anesthesia ready time included decreasing weight (0.3 min/10 kg, 95% CI, 0.1-0.6; P = .011), prematurity (1.5 minutes, 95% CI, 0.8-2.2; P < .001), and presence of chromosomal abnormality (3.4 minutes, 95% CI, 1.5-5.2; P < .001). An increase in the duration in anesthesia ready time was seen with increasing Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery mortality category with an additional 7.8 minutes (95% CI, 5.2-10.4; P < .001) for a Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery 5 procedure compared with Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery 1. Emergency versus elective case designation was associated with an anesthesia ready time reduction of 3.6 minutes (95% CI, 1.1-6.1; P = .005), and an afternoon case start was associated with an anesthesia ready time reduction of 4.2 minutes (95% CI, 2.8-5.6; P < .001). The presence of an anesthesia trainee increased the anesthesia ready time by 3.8 minutes (95% CI, 2.6-5.0; P < .001). The presence of an airway in situ decreased the anesthesia ready time by 3.6 minutes (95% CI, 1.6-5.5; P < .001), whereas an in situ arterial line decreased the anesthesia ready time by 7.4 minutes (95% CI, 4.6-10.2; P < .001). Placement of a central venous line increased the anesthesia ready time by 8.5 minutes (95% CI, 5.9-11.1; P < .001). Conclusions: The median anesthesia ready time was 51 minutes. For patients with characteristics associated with prolonged anesthesia ready time, consideration should be given to allocation of additional anesthesia staffing to improve efficiency.http://www.sciencedirect.com/science/article/pii/S2666273623001778anesthesiacongenital cardiac surgeryoperating room efficiencyperioperative care |
| spellingShingle | Morgan L. Brown, MD, PhD Steven J. Staffa, MS Luis G. Quinonez, MD James A. DiNardo, MD Viviane G. Nasr, MD, MPH Predictors of anesthesia ready time: Analysis and benchmark dataCentral MessagePerspective JTCVS Open anesthesia congenital cardiac surgery operating room efficiency perioperative care |
| title | Predictors of anesthesia ready time: Analysis and benchmark dataCentral MessagePerspective |
| title_full | Predictors of anesthesia ready time: Analysis and benchmark dataCentral MessagePerspective |
| title_fullStr | Predictors of anesthesia ready time: Analysis and benchmark dataCentral MessagePerspective |
| title_full_unstemmed | Predictors of anesthesia ready time: Analysis and benchmark dataCentral MessagePerspective |
| title_short | Predictors of anesthesia ready time: Analysis and benchmark dataCentral MessagePerspective |
| title_sort | predictors of anesthesia ready time analysis and benchmark datacentral messageperspective |
| topic | anesthesia congenital cardiac surgery operating room efficiency perioperative care |
| url | http://www.sciencedirect.com/science/article/pii/S2666273623001778 |
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