Comparison of operating room inefficiencies and time variability in laparoscopic gastric bypass.

Background: Improving operating room (OR) inefficiencies has financial and operational ramifications. However, their incidence has not been systematically studied, especially in bariatric surgery. Objectives: The study aimed to identify the operational inefficiencies of the laparoscopic Roux-en-Y gastric bypass (LRYGB) procedure, specify the steps of the procedure, and investigate whether the inefficiencies are related to case-by-case variability, using a surgical application. Setting: University Hospital, United States Methods: From July 2018 to January 2019, we observed consecutive nonrevisional LRYGB cases. We used a surgical application to capture in real-time all the inefficiencies/incidents that occurred inside the operating room. The duration and time variability, along with the number of incidents of each step, were recorded. Additionally, a multivariable analysis was conducted to investigate whether patient factors (age, race, body mass index, and American Society of Anesthesiologists physical status classification), surgeon and surgical-technician experience, resident-assist, and case difficulty affect the number of incidents. Results: Forty LRYGB procedures were observed. The duration of the procedural steps was linearly correlated with the number of incidents but case-to-case step duration variability was not. The steps that were linked with more inefficiencies included jejunojejunostomy creation that included more unrelated to the case conversations, and gastric pouch creation that had more anesthesia-related delays. Inefficiencies such as equipment malfunctions and missing supplies were equally distributed among all the steps. Multivariable analysis did not indicate that any of the tested factors were associated with the number of incidents. Conclusion: The use of the surgical app allowed us to accurately record the duration, variability, and the undesired incidents of each LRYGB procedural step. Future studies should target interventions to minimize the inefficient procedural steps we have identified to optimize operating room efficiency. (C) 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.