Assessing the Impact of Institutional Factors on Operating Room Inefficiencies in Anterior Cervical Discectomy and Fusion

Introduction: Anterior cervical discectomy and fusion (ACDF) is a common spine surgery with generally favorable outcomes but can be prone to operational inefficiencies. Understanding how institutional practices impact resource use and outcomes is crucial, especially in academic settings where operating room (OR) efficiency affects patient care and training. This study examines factors influencing length of stay (LOS), discharge disposition, and case duration in ACDF to optimize OR efficiency and patient outcomes.

Methods: This retrospective study evaluated OR efficiency in ACDF procedures in a large hospital system. Elective ACDF cases performed between January 1, 2021, and December 31, 2022, across three hospitals were included. Data on patient demographics, disease characteristics, and institutional factors were collected, along with time intervals related to surgery. Statistical analyses, including chi-square tests, Fisher’s exact tests, and analysis of variance (ANOVA), were used to assess the impact of these factors on key outcomes such as LOS, discharge disposition, and case duration.

Results: A total of 530 ACDF procedures were performed by 24 surgeons. Patients with a Charlson Comorbidity Index (CCI) less than 3 were associated with significantly shorter LOS and higher rates of discharge to home, though nearly all patients were ultimately discharged home regardless of CCI. The day of the week had a significant impact on both LOS and case duration, with surgeries performed on Wednesdays demonstrating the shortest LOS and case duration. While first case starts were associated with fewer surgical delays, neither first case starts nor the presence of delays significantly affected LOS, discharge disposition, or case duration.

Conclusion : Both patient-specific and institutional factors play a significant role in determining LOS, discharge disposition, and case duration in ACDF procedures. Optimizing OR scheduling, reducing delays, and addressing staffing challenges are critical strategies for enhancing resource utilization and patient outcomes in spine surgery.