TABLE 3.
Patient-Level Differences in Exposure to Hospital-Level OR Resources Among Patient Who Died and Were Discharged Alive
| Hospital Level Resources, Policies, or Procedures Aimed at Ensuring Access to Operation |
Survived to Discharge (n = 3439), n (%) |
Died (n = 181), n (%) | p value |
|---|---|---|---|
| Total operating rooms, median (IQR) | 19 (9–28) | 20 (10–33) | 0.03 |
| Block time for EGS | 0.40 | ||
| <1 d (none, <1) | 2,150 (62.5) | 110 (60.8) | |
| 1–4 d (1, 2, 3, 4) | 231 (6.7) | 8 (4.4) | |
| ≥5 d (5, >5) | 960 (27.9) | 55 (30.4) | |
| Tiered system for booking emergent surgical cases | 2,510 (73) | 144 (79.6) | 0.38 |
| Process to defer elective cases | 2,476 (72) | 136 (75.1) | 0.97 |
| Overnight OR access available | 3,417 (99.4) | 178 (98.3) | 0.98 |
| Total number of surgeons covering EGS, Median (IQR) | 5 (3, 8) | 7 (4, 9) | 0.87 |
| Daytime surgeons covering EGS free of other clinical duties | 745 (21.7) | 47 (26) | 0.26 |
| Daytime surgeon on call for EGS working postcall (%) | 0.78 | ||
| Always/often | 2,118 (61.6) | 109 (60.2) | |
| Sometimes | 480 (14) | 28 (15.5) | |
| Rarely/never | 648 (18.8) | 37 (20.4) | |
| Daytime EGS coverage scheme | 0.46 | ||
| On service weeks—5 consecutive days or greater (reference) | 524 (15.2) | 26 (14.4) | |
| Ad hoc daytime shift coverage | 518 (15.1) | 35 (19.3) | |
| Traditional 24-hour coverage | 2,023 (58.8) | 104 (57.5) | |
| Other | 66 (1.9) | 5 (2.8) | |
| In-house surgeon overnight for EGS | 0.01 | ||
| Always/often | 1,627 (47.3) | 105 (58) | |
| Sometimes | 269 (7.8) | 7 (3.9) | |
| Rarely/never | 1,358 (39.5) | 63 (34.8) | |
| Overnight surgeon also responsible for covering trauma | 0.16 | ||
| Always/often | 2,223 (64.6) | 129 (71.3) | |
| Sometimes | 133 (3.9) | 3 (1.7) | |
| Rarely/never | 898 (26.1) | 43 (23.8) | |
| Overnight surgeon also responsible for covering ICU care | 0.45 | ||
| Always/often | 1,335 (38.8) | 79 (43.6) | |
| Sometimes | 381 (11.1) | 17 (9.4) | |
| Rarely/never | 1,534 (44.6) | 77 (42.5) | |
| Overnight surgeon also responsible for covering EGS at more than one hospital | 0.17 | ||
| Always/often | 420 (12.2) | 21 (11.6) | |
| Sometimes | 391 (11.4) | 13 (7.2) | |
| Rarely/Never | 2,432 (70.7) | 139 (76.8) | |
| Overnight scrub techs | 0.04 | ||
| None | — | — | |
| On-call | 1,534 (44.6) | 66 (36.5) | |
| In-house | 1,865 (54.2) | 111 (61.3) | |
| Overnight OR nurses | 0.17 | ||
| None | — | — | |
| On-call | 1,560 (45.4) | 72 (39.8) | |
| In-house | 1,839 (53.5) | 105 (58) | |
| Overnight recovery room nurses | <0.01 | ||
| None | 53 (1.5) | 2 (1.1) | |
| On-call | 2,405 (69.9) | 100 (55.2) | |
| In-house | 929 (27) | 74 (40.9) | |
| Overnight anesthesia staff (MD, DO, CRNA) | 0.20 | ||
| None | 95 (2.8) | 2 (1.1) | |
| On-call | 1,464 (42.6) | 70 (38.7) | |
| In-house | 1,838 (53.4) | 106 (58.6) | |