OR Manager - November 2019 - 32

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At a Glance
Using AI to improve OR efficiency
In this study, a machine learning algorithm
resulted in the most accurate estimation
of operative case-time duration.
Researchers developed models to
predict case-time duration using linear
regression and supervised machine
learning. Each model included an allinclusive
model, service-specific models,
and surgeon-specific models. The
data set used included 46,986 scheduled
surgical procedures performed at a
large academic medical center.
The machine learning algorithm resulted
in the highest predictive capability,
and the surgeon-specific model was
superior to the service-specific model.
The ability to predict cases within
10% improved from 32% using the hospital's
institutional standard to 39%
using the machine learning surgeonspecific
model.
-Bartek M A, Saxena R C, Solomon S,
et al. J Am Coll Surg. Published online
July 13, 2019.
Outpatient coronary procedures
In a proposed rule, the Centers for Medicare
& Medicaid Services (CMS) is considering
whether to reimburse for percutaneous
coronary interventions (PCIs)
at ambulatory surgical centers, the September
20 tctMD reports.
As of May 1, 2019, approximately
22 states allowed for coronary interventions
to be done outside the hospital,
but the interventions were covered by
private payers.
CMS is proposing adding angioplasty
and stenting to covered procedures.
Future rule-making may consider percutaneous
procedures such as atherectomy,
PCI of or through a coronary artery
bypass graft, and revascularization of
chronic total occlusions.
-https://www.tctmd.com/news/cmsweighs-reimbursement-out-hospital-coronary-interventions
SSIs
in total joints tied to
comorbidities
This study found that surgical site infections
(SSIs) occurred most commonly
after total joint replacement revision
procedures and were related to many
patient comorbidities, which were significantly
associated with a higher risk
of SSIs.
In this analysis of 335,134
total knee replacements (TKRs) and
163,547 total hip replacements (THRs),
SSI rates were 15.6% and 8.6% after
revision TKRs and revision THRs, respectively,
compared with 2.1% after
both primary TKRs and primary THRs.
Comorbidities with the greatest adjusted
effect on SSIs across all total
joint replacements were: acquired immunodeficiency
syndrome, paralysis,
coagulopathy, metastatic cancer, and
congestive heart failure. Obesity and diabetes
also increased the risk of SSIs.
-Edmiston C E, Chitnis A S, Lerner J, et
al. Am J Infect Control. Published online
May 7, 2019.
Underreporting of needlesticks
This national survey of surgical residents
found that needlesticks occur frequently,
many events are not reported,
and numerous reporting barriers exist.
Of 7,395 respondents from all 260
general surgery residency programs,
27.7% noted experiencing a needlestick
in the last 6 months. Most events occurred
in the OR (77.5%) and involved
residents sticking themselves (76.2%)
with solid needles (84.7%).
Self-reported factors included residents'
own carelessness (48.8%) and
feeling rushed (31.3%).
Resident-level factors included senior
residents vs first-year residents
(29.9% vs 22.4%), female vs male gender
(31.9% vs 25.2%), or frequently
working more than 80 hours per week.
More than one-fourth of residents
(28.7%) did not report the needlesticks
to employee health.
The findings may help identify ways
to reduce needlesticks, the researchers
say.
-Yang A D, Quinn C M, Brock Hewitt D,
et al. J Am Coll Surg. Published online
September 18, 2019.
32
OR Manager | November 2019
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OR Manager - November 2019

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