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Timing Is Everything: Surgery Scheduling and OR Utilization

Nathan, Naveen MD

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doi: 10.1213/ANE.0000000000005932

Many variables influence the precision with which predicted surgical block time aligns with the actual duration of procedures, otherwise known as operating room utilization (ORU). The medical complexity of the patient, acuity of surgery, and operator experience are amongst some of the more logical factors that may alter the time spent in the operating room. Operating room under-utilization occurs when surgical duration is shorter than the predicted time frame. Conversely, over-utilization occurs when surgical duration exceeds the forecasted time frame. When ORU is over-utilized, the unintended consequences of case delays, case cancellations, and patient dissatisfaction may occur. One factor that may impact the accuracy of ORU is the timing of scheduling a procedure relative to the actual day of surgery. It is currently unknown whether surgical scheduling significantly impacts ORU and if so, to what magnitude. Lee et al performed a retrospective analysis to explore this potential relationship.

Over 27,000 surgical procedures across a two year time frame at a single academic medical center were reviewed. The precision of ORU was characterized by the ratio of actual case duration over forecasted time in the operating room (A/F ratio). As seen in this infographic, when patients were scheduled for their surgery within 7 days of the actual day of the procedure, over-utilization occurred. Interestingly, this effect was only seen for elective procedures in which there was planned admission after surgery. More investigations into the dynamic relationship between surgical scheduling and ORU are warranted. The reader is encouraged to review the cited article for a full scope and depth of understanding of the methods, results, and interpretation of this study.


    1. Lee SH, et al. The association between timing of elective surgery scheduling and operating theater utilization: a cross-sectional retrospective study. Anesth Analg. 2022;134:455–462.
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