Delay of surgery start time: Experience in a Nigerian teaching hospital

Chike John Okeke; Chukwudi Ogonnaya Okorie; Rufus Wale Ojewola; Njoku Isaac Omoke; Anselm Okwudili Obi; Agama Nnachi Egwu; Okechukwu Valentine Onyebum

doi:10.4103/njs.NJS_61_19

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ORIGINAL ARTICLE

Year : 2020 | Volume : 26 | Issue : 2 | Page : 110-116

Delay of surgery start time: Experience in a Nigerian teaching hospital

Chike John Okeke¹, Chukwudi Ogonnaya Okorie², Rufus Wale Ojewola³, Njoku Isaac Omoke², Anselm Okwudili Obi², Agama Nnachi Egwu², Okechukwu Valentine Onyebum⁴
¹ Department of Surgery, Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State; Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Surulere, Lagos, Nigeria
² Department of Surgery, Alex-Ekwueme Federal University Teaching Hospital; Department of Surgery, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
³ Department of Surgery, Lagos University Teaching Hospital; Department of Surgery, College of Medicine, University of Lagos, Idi-Araba, Surulere, Lagos, Nigeria
⁴ Department of Surgery, Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria

Correspondence Address:
Dr. Chike John Okeke
Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Surulere, Lagos
Nigeria

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/njs.NJS_61_19

Background: Operating room delay has multiple negative effects on the patients, surgical team, and the hospital system. Maximum utilization of the operating room requires on-time knife on the skin and efficient turnover. Knowledge of the reasons for the delay will form a basis toward proffering solutions. Patients and Methods: This was a prospective study of all consecutive elective cases done over a 15-month period from January 2016 to March 2017. Using our departmental protocol that “knife on skin” for the first elective case should be 8.00am, the delay was defined as a surgery starting later than 8.00am for the first cases while the interval between the cases of >30 min for the knife on the skin was used for subsequent cases. Reasons for delay in all cases of delay were documented. The prevalence and causes of the delays were analyzed. P < 0.05 was considered statistically significant. Results: Of 1178 surgeries performed during the period of study, 1170 (99.3%) of cases were delayed. The mean delay time was 151 min for all cases. First on the list had a longer delay time than others; 198.9 min versus 108.5 min (P = 0.000). Delay in the first cases accounted for 47.5% of all delayed cases. Overall, patient-related factor was the most common cause of delay (31.3%) followed in descending order by surgeon-related factor (28.5%) and hospital-related factor (26.2%). Patient-related factors accounted for 43.2% of first-case delays. Conclusion: Delays encountered in this study were multifactorial and are preventable. Efforts should be directed at these different causes of delay in the theater to mitigate these delays and improve productivity.

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