Table 1.
Base case model inputs
| Parameter | Default valuea | Source |
|---|---|---|
| Time Horizon | 1 month (21 working days) | Assumption |
| Operating Room | ||
| Start of OR day | 7:30 AM | Assumption |
| End of OR day | 4:00 PM | Assumption |
| Time from start of OR day to OR admission of first patient | 10 min | [36] |
| Time between procedures (turnover time) | 35.6 min | [37] |
| Time for OR clean-up/prep for next day | 15 min | Assumption |
| Procedure | ||
| Number of procedures per day | 5 | Assumption |
| Mean time per procedure with neostigmine use | 72.9 min | Analysis of RECITE Canada data (data on file) |
| Probability of cancellation of schedule procedure (unrelated to OR time over-run) | 10.7% | [38] |
| Is next procedure moved up when cancellation occurs? | No | Assumption |
| Can a procedure be cancelled because there is not enough OR time available? | Yes | Assumption |
| Cancellation policy | No procedures may begin after end of OR day | Assumption |
| Probability of emergency procedure insertion | 0% | Assumption |
| Probability of semi-emergency procedure insertion | 0% | Assumption |
| Residual Neuromuscular Block | ||
| Risk of residual block at extubation with neostigmine use | 60.0% | [6, 19, 20] |
| Absolute excess risk of hypoxemia with residual block | 24.5% | [33] |
| Absolute excess risk of upper airway obstruction with residual block | 44.2% | [6, 32] |
| Impact of Sugammadex vs. Neostigmine | ||
| Reduction in time from patient OR admission to OR discharge | ||
| All patients verified to have full neuromuscular recovery (TOF ratio ≥0.9) prior to extubation in the OR | 14 min | Grintescu et al. 2009 [16]; P318 2010 [13] |
| No patients verified to have full neuromuscular recovery (TOF ratio ≥0.9) prior to extubation in the OR | 0 min | P334 2009 [12]; P07981 2013 [14]; P07038 2014 [15] |
| Reduction in risk of residual neuromuscular blockade at extubation, among patients not verified to have full neuromuscular recovery (TOF ratio ≥0.9) prior to extubation | 93% | [6] |
| OR Staff Eligible for Overtime Pay | ||
| Registered nurses | 3 present | Assumption |
| Respiratory therapist | 1 present | Assumption |
| Nurse aide | 1 present | Assumption |
| Overtime pay policy | 30 min increments | Assumption |
OR Operating room
aAssumed Arena probability distributions [Mean time per procedure with neostigmine use (LOGN 72.9,29.2); Turnover time (10+EXPO{25.6}); Time to OR admission of 1st patient (DISC{0.5,5,1,15});OR clean-up time (TRIA{7.5,15,22.5})]