Improving operating efficiency with emphasis on prosthetic surgery

摘要

Dear Editor, Physicians are looking for methods and techniques to become more efficient and more productive. Not only is efficiency important in the office and clinical setting, but in the operating room as well. This article will discuss efficiency and productivity in the operating room and its benefit to patients, surgeons and hospitals. Physicians today are challenged like no other time in our glorious history. Trends are taking place moving surgical patients from the operating room to the office setting using minimally invasive surgery instead of hospital procedures. There is a trend from open surgery to robotic and laparoscopic surgery. There is a movement from solo practice to large group practices, and younger physicians are being employed by hospitals instead of joining groups or starting a solo practice. There is also a trend for physicians to become involved in the business of medicine and many are pursuing combined MD and MBA degrees. Physicians have become concerned as reimbursements are decreasing, overhead costs are rising, and incomes are decreasing as a result. Compounding that problem, we are going to be faced that over 20 million patients are going to be added to the healthcare system in the United States as a result of the passage of the Affordable Care Act. The aging baby boomers will have increasing medical problems requiring our attention, and there will be additional demands upon physicians, particularly urologists. With physicians retiring at an earlier age and inadequate replacements to accommodate the increased number of patients, there is going to be a serious time challenge to physicians. The take home message is that physicians and hospitals are going to have to be more efficient and more productive in order to accommodate our future. One opportunity for all urologists who perform penile implant surgery is to improve their efficiency in the operating room. This article will discuss the advantages to patients, to surgeons and to hospitals for becoming more efficient in the operating room. Techniques especially useful to penile implant surgery will be presented. ADVANTAGES TO PATIENTS With the use of intraoperative injections of long-acting local anesthetics, such as bupivacaine and ropivacaine, there is a reduction in postoperative pain medication requirements in men who have had penile implant surgery.1 A reduction in pain and a reduced requirement for narcotics and opioids also reduces the risk of acute urinary retention requiring a catheter which prolongs recovery and leads to increased discomfort for the patient and requires a trial of voiding the following day, which may prolong hospitalization and/or require an additional office visit.2 Published studies suggest that surgeons who have a greater volume of cases and more operative experience have fewer reported postoperative complications.3456 These studies cover a wide variety of surgical procedures, and given the scope of the evidence, it seems logical that the conclusion may be transferred to surgeons performing penile prosthetic surgery. Multiple studies have demonstrated that longer operative time increase the possibility of operative field contamination, which may lead to an increased risk of surgical site infection.78910 If, indeed, surgeon experience and shorter operative times lead to fewer complications, it naturally follows that overall patient outcomes from prosthetic surgery will be improved. In addition, with fewer postoperative complications, the rehabilitation time or the time to device activation is reduced. With less tissue trauma, less scrotal hematomas, and faster recovery time, the patient can begin having sexual intimacy sooner than patients who spend longer times in the operating room. This translates not only to a happier patient, but also a happier partner, which is a large part of the equation in caring for men with erectile dysfunction.11 Finally, there is a cost issue that impacts patients who are paying out of pocket