Correspondence  |   June 2006
The Elephant in the Operating Room
Author Affiliations & Notes
  • Robert Hanss, M.D.
  • *University-Hospital Schleswig-Holstein, Kiel, Germany.
Article Information
Correspondence   |   June 2006
The Elephant in the Operating Room
Anesthesiology 6 2006, Vol.104, 1342-1343. doi:
Anesthesiology 6 2006, Vol.104, 1342-1343. doi:
In Reply:—
We thank Dr. Metz for his comment on our study.1 We agree with the drawn conclusions. In fact, surgical performance is a key point of operating room efficiency.
The different studies demonstrated measures to successfully reduce anesthesia-related time intervals.1,2 Measures such as overlapping induction of anesthesia, implementation of anesthesia induction rooms, and introduction of a deliberate perioperative system improved anesthesia workflow with increase of anesthesia efficiency. These improvements may be deteriorated by inefficient surgical performance.
Anesthesiologists have been investigating operating room time flow for a long time. This should exert pressure on our surgical colleagues to challenge their procedures as well. Nevertheless, one must keep in mind that the fastest surgeon may not be the best one in terms of the patient's safety, intensive care unit stay, total hospital stay, and rate of complications. Therefore, quality of an operation is a complex, multifactorial task, and surgical case duration is only one (nevertheless important) part of it.
We hope that there will be several studies in the near future published in surgical journals as well, demonstrating measures to improve surgical work flow and efficiency showing an increase of surgical quality.
*University-Hospital Schleswig-Holstein, Kiel, Germany.
Hanss R, Buttgereit B, Tonner PH, Bein B, Schleppers A, Steinfath M, Scholz J, Bauer M: Overlapping induction of anesthesia: An analysis of benefits and costs. Anesthesiology 2005; 103:391–400Hanss, R Buttgereit, B Tonner, PH Bein, B Schleppers, A Steinfath, M Scholz, J Bauer, M
Torkki PM, Marjamaa RA, Torkki MI, Kallio PE, Kirvela OA: Use of anesthesia induction rooms can increase the number of urgent orthopedic cases completed within 7 hours. Anesthesiology 2005; 103:401–5Torkki, PM Marjamaa, RA Torkki, MI Kallio, PE Kirvela, OA
Sandberg WS, Daily BM, Egan M, Stahl JE, Goldman JM, Wiklund RA, Rattner D: Deliberate perioperative systems design improves operating room throughput. Anesthesiology 2005; 103:406–18Sandberg, WS Daily, BM Egan, M Stahl, JE Goldman, JM Wiklund, RA Rattner, D