A ^Retired Plastic Surgeon's Notebook

Why it’s so hard to estimate operative times.

Time is a tough thing to estimate.

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder, blogs about the difficulty in estimating surgery time.

Today I was chatting with one of the anesthesiologists who works in our office O.R. about estimating time for surgical procedures.  It is really an art and science and frankly, sometimes a crapshoot.

The clock starts ticking from the minute the patient walks or is wheeled into the operating room.  The things that need to be done before I even make an incision include putting on monitors, putting on a warming blanket and compression stockings (to prevent blood clots), getting an I.V. started, checking blood pressure and oxygen saturation,  giving medications, giving the patient a nice blast of oxygen, helping the patient drift off to sleep, putting in an airway device and then making sure the positioning on the O.R. table is just right.  Then the operative area needs to be washed off with antiseptic and draped with sterile drapes.  Oh, and of course we do a safety pause.  All of this takes place before I even start operating and any one delayed task can add to the O.R. time.  For example, if the patient has difficult veins, the I.V. can take a lot of time – up to 20 minutes.  If the positioning is difficult, that can add 5 – 10 minutes.  You get the idea.

Then there is the actual operation.  The most likely thing to add time to a surgical case is unexpected bleeding.  One little blood vessel that is difficult to control can lengthen operating room time by several minutes.  Ten little blood vessels can really run up the clock.  And then there is weird anatomy or something unexpected.  A good example of this is encountering a little hernia during a tummy tuck.  That can add 20 minutes.   These things are not dangerous but just time consuming.

And then there are a lot of cases where the planets are aligned just right and everything is  so smooth that we clock in way under the estimated time.

So individual surgical time is tough to predict, but that being said, I am getting pretty good when I go back and look at my average times over 6 months or so.  My predicted time and actual time varies only by about five minutes.

And looking at my times over the years, I am not getting any faster.  If there are shortcuts to doing careful surgery, I haven’t found them!

Thanks for reading!  Dr. Lisa Lynn Sowder, your friendly and chatty and American Board of Plastic Surgery certified surgeon.

 

Category: Plastic Surgery, Uncategorized | Tags: , , , , , ,

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