Presented by: Gabriel Molineros MD
Hadassah Ein Kerem

Introduction

Over the years, the field of endourology has experienced significant advances in surgical techniques, instrumentation, and patient care. The role of the anesthesiologist is a key factor which contributes to the overall effectiveness of endourological procedures. By providing proper anesthetic and perioperative care, skilled anesthesiologists play an essential duty in ensuring patient safety and optimizing surgical results. However, the real influence of experienced anesthesiologists on endourology time efficiency is unidentified. The aim of this study is to assess the extent to which a skilled anesthesiologist can save time during endourological procedures.

Materials

This paper presents a retrospective study of 2,195 patients who underwent retrograde intrarenal surgery (RIRS) or ureteroscopy at Hadassah Medical Center between 2013 and 2022. Among the patients studied, the endourology anesthesiologist was present in 1,893 cases, while other anesthesiologists were involved in the remaining 302 cases. By comparing these two groups, we examine the association between the presence of a skilled anesthesiologist and various time-related parameters, specifically focusing on anesthesia duration and extrapolating the results to the amount of cases that can be done yearly in our institution.

Results

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Significant differences in anesthesia duration between the two groups was identified. The endourology anesthesiologist (EA) demonstrates a mean anesthesia time of 19.78 minutes (SD = 15.23), with a minimum time of 1 minute and a maximum of 164 minutes. In contrast, the other anesthesiologists (OA) have a mean anesthesia time of 32.57 minutes (SD = 25.01), with a minimum time of 3 minutes and a maximum of 217 minutes. The T-score, comparing the EA to OA, is calculated to be -12.08, indicating a substantial difference. It is important to note that the anesthesia time considered in this study encompasses the duration from induction of anesthesia until extubation of the patient, excluding the duration of the surgical procedure itself. In the context of our institution, where an average of 64 hours of endourology block-time are allotted each month, we can extrapolate these results as it follows: The average duration of a case with EA is 30 minutes, while the average duration of a case with OA is 45 minutes. Number of cases with EA = 3,840 minutes / 30 minutes per case = 128 cases Number of cases with OA = 3,840 minutes / 45 minutes per case = 85.33 cases (approximately) Based on these calculations, with 64 hours of block-time per month, one can perform approximately 128 cases with EA and approximately 85 cases with OA.

Conclusion

Discussion and Conclusion:

The significantly shorter anesthesia time associated with EA suggests a more efficient administration and management of anesthesia, anticipation of the surgeon’s needs and intimate knowledge of the endourological workflow. This contributes to overall time savings in endourological procedures. With shorter OR times leading to an increase in the absolute number of cases per month, OR lead time and waiting lists can be significantly shortened. The significantly shorter anesthesia duration associated with the endourology anesthesiologist underscores the importance of expertise and experience in optimizing patient care and enhancing surgical efficiency. In our institution, as in others, the cumulative time savings can result in the dual effect of increasing profitability while expanding patient access to a vital clinical resource. The results of this study provide evidence of the time-saving benefits associated with a skilled anesthesiologist in endourology. The significantly shorter anesthesia duration observed with the EA emphasizes the importance of their role in optimizing patient care and enhancing overall surgical efficiency. These findings give an incredible output for healthcare providers, administrators, and policymakers, showing the need for skilled, or even designated, anesthesiologists in endourological teams to maximize time savings, improve patient outcomes, and enhance overall efficiency in the field.

Funding

there is not

Lead Authors

Conner Brown, MD
Hadassah Ein Kerem