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In Response

Dexter, Franklin MD, PhD; Epstein, Richard H. MD

doi: 10.1213/ANE.0000000000001917
Letters to the Editor: Letter to the Editor

Department of Anesthesia, Division of Management Consulting, University of Iowa, Iowa City, Iowa,

Department of Anesthesiology, University of Miami, Miami, Florida

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Definitions of Emergency, Urgent, and Elective (Scheduled) Surgery

Jacobs et al write: “Dexter et al … compared the total percentage of national anesthesia minutes performed on Saturday and Sunday [and] thereby estimat[ed] the prevalence of elective Saturday surgeries.”1,2 “Dexter et al convincingly showed that weekend elective surgery is not a common practice in the United States.1,2 However…we reject the thought that because weekend elective surgery is uncommon, it should not be implemented.”1 Jacobs et al “believe that an uncommon practice may still be beneficial…especially true in the field of orthopedic trauma.”1 They refer to “some of the busiest trauma centers in the country”; “many Level 1 trauma centers”; and “specific fracture patterns” such as “complex articular fractures and polytraumas.”1

From our page 1298, “a functional classification is that cases are emergent if they cannot wait safely for a team to come from home, elective if they can wait through the weekend without clinical or economic consequence (ie, patient is outpatient preoperatively), and urgent otherwise.”3–5 The 3 most common categories of procedures accounting for weekend elective surgery were (again from our page 1298) “colonoscopy, cholecystectomy and common duct exploration, [and] upper gastrointestinal endoscopy.”2 From our Table 1 of an “example of a US University hospital’s aborted initiative for Saturday elective schedule,” “to be scheduled, the historical average length of stay for the procedure needed to be ≤ 2 nights” and “the cases were scheduled” starting “2 weeks before the selected day.”2

As stated by Jacobs et al in their accurate summary of our results, the results apply only to elective case scheduling.1,2 Trauma is not elective (scheduled) surgery.

Franklin Dexter, MD, PhDDepartment of AnesthesiaDivision of Management ConsultingUniversity of IowaIowa City,

Richard H. Epstein, MDDepartment of AnesthesiologyUniversity of MiamiMiami, Florida

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1. Jacobs RC, Schottel PC, Tsai MH. Rationalizing orthopedic (and anesthesiology) weekend coverage. Anesth Analg. 2017;124:1375–1376.
2. Dexter F, Epstein RH, Campos J, Dutton RP. US national anesthesia workload on Saturday and Sunday mornings. Anesth Analg. 2016;123:1297–1301.
3. Dexter F, Macario A, Traub RD. Statistical method using operating room information system data to determine anesthetist weekend call requirements. AANA J. 2000;68:21–26.
4. Dexter F, O’Neill L. Weekend operating room on call staffing requirements. AORN J. 2001;74:664–665, 668–671.
5. van Oostrum JM, Van Houdenhoven M, Vrielink MM, et al. A simulation model for determining the optimal size of emergency teams on call in the operating room at night. Anesth Analg. 2008;107:1655–1662.
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