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Table 1 Base case model inputs

From: A discrete event simulation model of clinical and operating room efficiency outcomes of sugammadex versus neostigmine for neuromuscular block reversal in Canada

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

  1. OR Operating room
  2. 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})]
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BMC Anesthesiology

ISSN: 1471-2253

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