# Impact of Operating Room Efficiencies on Patient Outcomes Following Primary Coronary Artery Bypass Surgery

## TL;DR

This study shows that longer operating room times during heart surgery are linked to worse patient outcomes and higher costs.

## Contribution

The study identifies non-surgical operating room time as a novel predictor of adverse outcomes after CABG.

## Key findings

- Longer surgery times are associated with complications, longer hospital stays, and higher mortality.
- Increased non-surgery operating room time correlates with worse outcomes and higher costs.
- Improving OR efficiency could enhance patient outcomes after CABG.

## Abstract

Prolonged cardiopulmonary bypass (CPB) time during coronary artery bypass grafting (CABG) is associated with poor outcomes, however, the association of other operating room (OR) times is less understood. We studied the impact of OR times on outcomes and resource utilization after CABG.

Patients undergoing isolated primary CABG from a large multicentre regional collaborative were analysed. The impact of risk-adjusted total OR, surgery, non-surgery, CPB, and off-CPB times on morbidity, extubation time, ICU and hospital length of stay (LOS), cost, and mortality, was studied. Multivariable regressions were performed adjusting for STS predicted risk of morbidity or mortality, intraoperative blood transfusion, CPB time, cross-clamp time, presence of a cardiothoracic surgery fellowship program, and year of surgery. Our adjustment accounted for patient and intraoperative factors that contribute to complexity and intraoperative course of surgery. All models incorporated centre as a random effect to account for hospital-level variations.

Among 29 206 patients (mean age 64.8 years, 76% male), median OR, surgery, non-surgery, and CPB times were 308, 235, 72, and 141 minutes, respectively. Longer surgery times were significantly associated with complications, prolonged ventilation, longer ICU and hospital LOS, and mortality. Similarly, increasing non-surgery OR time was significantly associated with worse outcomes, including longer LOS and complications. Each additional 15 minutes in the OR was associated with increased odds of complications, mortality, and cost.

Longer non-surgical OR times are associated with adverse outcomes and increased cost. Improving OR efficiency may contribute to better patient outcomes.

There are many pre-operative, intraoperative, post-operative, and patient-related variables that impact the outcome of patients who have undergone coronary artery bypass surgery (CABG).