Surgical Workload and Cost of Postoperative Adhesion-related Intestinal Obstruction: Importance of Previous Surgery

Postoperative intraabdominal adhesions cause morbidity of varying degree. Intestinal obstruction is the most severe complication of adhesions. This study examined the importance of previous surgery on clinical and economic workloads caused by intestinal obstruction due to postoperative intraabdominal adhesions. All emergency hospitalizations due to adhesion-related intestinal obstruction from January 1, 1999 to December 31, 1999 in a hospital district serving roughly 450,000 inhabitants was reviewed retrospectively. The patient population was divided into six groups according to the site of previous surgery, and the total as well as group-related surgical workload and direct costs of inpatient care were analyzed. There were 123 hospitalizations due to postoperative adhesion-related intestinal obstruction during the study period. A total of 101 patients had experienced 176 operations. The most prevalent operations were colorectal (with or without other operations), upper abdominal, and female reproductive system procedures. Colorectal surgery preceded 40% and 38% of inpatient episodes and inpatient days, respectively. Altogether, 40 operations were performed because of adhesion-related intestinal obstruction. No differences between groups were seen in terms of the mean operating or theater time. Total annual inpatient costs due to emergency hospitalizations for intestinal adhesion-related obstruction related to colorectal surgery in a hospital district serving roughly 450,000 inhabitants was $72,520.60 (U.S. dollars) which accounted for 35.3% of all annual costs caused by postoperative adhesion-related intestinal obstructions. There were no significant differences between groups regarding the total mean inpatient episode costs. Intestinal obstruction due to postoperative adhesions poses substantial costs for the society. Colorectal operations are the most important procedures preceding adhesion-related intestinal obstruction, accounting for 35.3% to 46.8% of the total clinical workload or costs attributable to postoperative adhesion-related obstruction.     

Long-term follow-up and cost analysis following surgery for small bowel obstruction caused by intra-abdominal adhesions

BACKGROUND: This study examined the natural course of patients following surgery for small bowel obstruction (SBO) caused by abdominal adhesions. In addition, a cost analysis was performed. METHODS: A retrospective analysis was undertaken of 102 patients who underwent surgery between 1987 and 1992 for intestinal obstruction due to abdominal adhesions. RESULTS: Median follow-up was 14 years. The 102 patients experienced 273 episodes of intestinal obstruction after the index operation, of which 237 involved inpatient readmissions; 47.3 per cent of the episodes resulted in further surgery. Single band adhesions were more common in patients with no previous abdominal surgery (P < 0.001). Some 52.0 per cent of the patients had undergone only one operation for SBO. A mean of 2.7 episodes per patient occurred after the index operation. The cost of adhesion-related problems in this study was 1,588,594 euros or 6702 euros per inpatient episode. CONCLUSION: The readmission rate in a selected cohort of patients with proven intra-abdominal adhesions was higher than reported previously. The annual cost of adhesion-related problems in Sweden was estimated as 39.9-59.5 million euros, and the cost of inpatient readmissions was almost equal to that for gastric cancer.     

Small bowel obstruction due to postoperative adhesions: treatment patterns and associated costs in 110 hospital admissions

The workload and costs of the emergency admissions and treatment of adhesive small bowel obstruction (ASBO) are unclear. This review details and costs the admission workload of ASBO. All admissions over a 2-year period for ASBO at two district general hospitals were identified through ICD10 diagnostic codes. Diagnostic investigations, treatment patterns, ward stay and outcome information for admissions were detailed from clinical records to develop mean cost estimates and assess the associated workload. Of the 298 admissions identified, 188 were not due to ASBO and were excluded from analysis. Of the 110 admissions detailed, 41 (37%) were treated surgically and 69 (63%) conservatively. Most admissions occurred through general practitioner referral (86.4%) to accident and emergency (90.0%). Mean (SD) length of stay was 16.3 days (11.0 days) for surgical treatment and 7.0 days (4.6 days) for conservative treatment. In-patient mortality was 9.8% for the surgical group and 7.2% for the conservative group. Costs were based on the mean values from both centres for surgical and conservative admissions and detailed according to the cost of referral and follow-up (100.98 Pounds surgical versus 102.61 Pounds conservative), hospital ward and ICU stay (3,327.48 Pounds versus 1,267.92 Pounds), theatre time (832.32 Pounds surgical only), investigations (282.73 Pounds versus 207.33 Pounds) and drug costs (133.90 Pounds versus 28.29 Pounds). Total treatment cost per admission for ASBO was 4,677.41 Pounds for surgically treated admissions and 1,606.15 Pounds for conservatively treated admissions. The impact of admissions for ASBO is considerable in terms of both costs and workload. Bed stay for these admissions represents the equivalent of almost one surgical bed per year and at least 2 days theatre time, impacting on surgical capacity and waiting lists. Adhesion prevention strategies may reduce the workload associated with ASBO. The review provides useful information for planning resource allocation.     

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??Long-term follow-up following nonsurgery for early postoperative inflammatory intestinal obstruction LI You-sheng,LI Min,LI Ning, et al. Department of Surgery, Nanjing General Hospital of Nanjing Command, Nanjing 210002, China
Corresponding author: LI You-sheng, E-,mail: liys@medmail.com.cn
Abstract Objective To examine the results of treatment for the early postoperative inflammatory intestinal obstruction and long-term follow-up. Methods A retrospective analysis of 121 patients with early postoperative inflammatory intestinal obstruction from January 1999 to December 2008 was undertaken. Patients’ medical records were reviewed in their entirety. A systematic follow-up was carried out and ended in March 2009. The primary endpoint and secondary endpoint of the study were surgery and the recurrence rate of intestinal obstruction caused by intra-abdominal adhesions. Results All patients were treated conservatively. The follow-up period was 2-116??43.23±12.75?? months. Overall, 14(11.57%) of the 121 patients had recurrent episodes of intestinal obstruction and 6 patients (4.96%) had a least a admission. No patient had undergone operation for intestinal obstruction.Conclusion Non-operative treatment for early postoperative inflammatory intestinal obstruction has a lower cumulative recurrence rate following a long-term follow-up. Operative treatment is not deemed necessary.     

Estimation of the additional costs of chemotherapy for patients with advanced non-small cell lung cancer

BACKGROUND: A large multicentre randomised trial, the Big Lung Trial, which in part compared supportive care with or without cisplatin-based chemotherapy in patients with advanced non-small cell lung cancer, provided an opportunity to evaluate the impact on the UK National Health Service of the costs incurred with the use of chemotherapy. METHODS: This costing study was based on the retrospective collection of resource use data from hospital records. Case notes from 194 patients (98 chemotherapy + supportive care (C), 96 supportive care alone (NoC)) were inspected in eight centres recruiting the largest numbers of patients into the Big Lung Trial. Quantities were multiplied by fixed unit costs to calculate a total cost for each patient. The main outcome measure was the total cost incurred by the use of secondary care resources (including investigations, chemotherapy, radiotherapy, surgical procedures, inpatient days, outpatient attendances, and hospice inpatient care) in the two groups. RESULTS: Patients randomised to receive cisplatin-based chemotherapy had an average of 3.4 more inpatient bed days than the mean of 11.9 days for patients randomised to supportive care alone, and more outpatient attendances. NoC patients were more likely to have received palliative radiotherapy. The mean total cost for C patients was 5355 sterling pound compared with 3595 sterling pound for the NoC group, difference 760 sterling pound (95% CI 781 sterling pound to 2742 sterling pound ). When split, the cost in the C group associated with the administration of chemotherapy was 1233 sterling pound and non-chemotherapy costs were 4122 sterling pound . CONCLUSION: The additional cost of chemotherapy was not offset by a reduction in subsequent costs (as the non-chemotherapy costs were similar), so the survival benefit of about 10 weeks observed in the C group was achieved with the cost of chemotherapy administration.     

Current spectrum of intestinal obstruction

In a 12-month prospective study incorporating four neighbouring district general hospitals, 228 patients required a total of 236 admissions with intestinal obstruction. The aetiological factors included adhesions 75 (32 per cent), malignant disease 61 (26 per cent), strangulated hernias 59 (25 per cent), volvulus 10 (4 per cent), acquired megacolon 6 (3 per cent), pseudo-obstruction 4 (2 per cent), faecal impaction 6 (3 per cent) and miscellaneous 15 (6 per cent). The peak incidence for obstruction due to adhesions, malignant disease and strangulated hernias each occurred in the eighth decade. Surgery was performed within 48 h of admission in 29 per cent adhesive obstructions (22), 30 per cent obstructions due to malignant disease (18) and 68 per cent strangulated hernias (40)--bowel resection rates in these three groups were 13.5, 50 and 29 per cent, respectively. The overall mortality was 11.4 per cent (26 deaths) and postoperative mortality was 12.3 per cent (19 deaths). During the 12-month study period, 228 patients required a total of 2993 inpatient hospital days as a result of intestinal obstruction. Postoperative adhesions have become the commonest cause of intestinal obstruction but strangulated hernias and intra-abdominal malignant disease still account for 50 per cent of all cases and mortalities. Obstruction due to strangulated hernias and intra-abdominal malignant disease typically occurs in the elderly age group where a more aggressive policy of elective surgical intervention is likely to be associated with increased postoperative morbidity and mortality.     

Laparoscopic management of acute small bowel obstruction

BACKGROUND: Conventional surgical management of acute small bowel obstruction involves laparotomy. The laparoscopic approach has not been favoured due to the presumed increased risk of bowel injury. METHODS: A retrospective review of our experience of laparoscopic management of acute small bowel obstruction was undertaken. Nine patients were identified from 1997 to 2003. The aetiology of obstruction was identified laparoscopically in all cases. Eight cases were caused by bands or local adhesions and one patient had a bezoar. RESULTS: Laparoscopic treatment was successful in 78% of patients including one laparoscopy-assisted procedure. Conversion to laparotomy was performed in two patients, one due to difficult adhesiolysis and one due to iatrogenic bowel injury during adhesiolysis. The mean operating time was 74 minutes. There were no postoperative complications and the mean length of hospital stay was 4.3 days. CONCLUSION: This small series demonstrates that laparoscopy can serve as a good diagnostic tool as well as treatment of acute small bowel obstruction. In an appropriately selected patient, laparoscopic management of small bowel obstruction is a feasible therapeutic approach and appears to convey the benefits of a short postoperative hospital stay, reduced postoperative complications and possibly reduced subsequent adhesion formation.     

The cost of a major paediatric burn

There is little written on the financial cost of burns care. This project examined three major paediatric burns of 30–40% total body surface area (%TBSA) admitted to the South West Paediatric Burns Service in Bristol, and calculated the cost per patient of acute inpatient treatment. A list of costs was established for theatre time, bed time, medications and fluids, dressings, invasive procedures, therapy services and investigations. The time period was the initial inpatient stay, from admission to the burns service, to first discharge. Staff in the relevant managerial and purchasing departments provided additional information about charging. We calculated a mean cost per patient of £63,157.22 (range £55,354.79–£74,494.24).     

Randomized clinical trial of the effectiveness of emergency day surgery against standard inpatient treatment

BACKGROUND: The aim of this study was to assess the feasibility of treating patients with minor and intermediate general surgical emergency conditions as day cases. METHODS: Emergency referrals for minor and intermediate general surgical conditions were assessed by a surgeon. Those fitting day-case criteria and requiring operation under general anaesthesia were randomized to receive standard inpatient care or day surgery. Patients in the latter group were booked on to day-case lists or gaps on inpatient elective lists for surgery within 48 h. The process was coordinated by an experienced theatre sister. RESULTS: One hundred patients were randomized. There was a reduction in the number of nights spent in hospital in the day-case group (median 0 versus 2 nights; P < 0.001). The median time from diagnosis to treatment was 1 day in both groups, although there was a small but significant delay in the day-case group (P = 0.018). There was no significant difference in postoperative outcome or patient and general practitioner satisfaction. The day-case option had no increased impact on primary care services but was associated with a significant saving of about pound sterlings 150 per patient (P < 0.001).CONCLUSION: Certain general surgical emergencies may be managed as day cases with cost saving but without detriment to patient care.     

Small bowel obstruction caused by postoperative adhesions: personal experience and review of the literature

Small bowel obstruction due to postoperative adhesions still remains an important matter in terms of frequency, diagnostic and therapeutic commitment and costs. The Authors report on a series observed over 14 years consisting of 63 patients (71 cumulative hospital admissions). Surgery was required in 42 cases (59.2%), 23 cases were treated in emergency and 19 cases after failure of conservative treatment. In 29 cases (69%) the surgical procedure was limited to adhesiolysis, whereas in 13 cases (31%) an intestinal resection was performed. During operation the mechanisms responsible for obstruction were: strangulation by an adhesive band (39.4%), angulation (34%), bowel loops and volvulus glued together (13.2% in each case). The operative mortality was 4.7% (2 cases). In 29 cases (40.8%), after medical treatment, the obstruction was completely resolved within a mean period of 4.15 days (range: 2-8). The results lead to the conclusion that diagnostic accuracy in cases of obstruction due to postoperative adhesions is still uncertain. The main aspects of treatment and surgical timing are left to the surgeon's personal experience. Medical treatment, however, should be the first therapeutic option and, in case of doubt, further diagnostic investigations are necessary (mainly CT) to identify those cases amenable to surgical treatment.     

Lipid emulsions prevent postoperative abdominal adhesions

IntroductionAdhesions are the most common cause of long-term morbidity after abdominal surgery and most often cause various forms of intestinal passage disorders ranging from partial obstruction to complete, life-threatening intestinal obstruction. The aim of the present study was to evaluate the protective effect of intraperitoneally administered lipid emulsions on the formation of adhesions in larger animal model, as the lubricating effect of phospholipids and the mechanical barrier of the lipid component are combined with the anti-inflammatory effect of fish oil.MethodsThirty-one female domestic pigs were randomly divided into three groups. At the end of the surgical procedure, a lipid emulsion or saline solution was applied intraperitoneally. After 14 days, an independent macroscopic, histological and immunohistochemical evaluation of the adhesions were performed.ResultsIntraperitoneal administration of lipid emulsions significantly reduced the incidence of intra-abdominal adhesions. Microscopic examination demonstrated a significant reduction in the number of inflammatory elements and the amount of collagen in the adhesions, especially after administration of the fish oil-based emulsion. A simultaneous decrease in neovascularization was observed in the adhesions. Evaluation of the intestinal anastomosis did not reveal significant differences in healing between the groups.ConclusionIntraperitoneal administration of lipid emulsions can reduce the development of postoperative intra-abdominal adhesions by the combined action of phospholipids as important lubricants and lipids as a mechanical barrier. Their effect is caused by a reduction in proinflammatory and profibrotic mediators. At the same time, intraperitoneal administration of lipid emulsions does not impair healing of the anastomosis in larger animal model.     

Adhesive postoperative small bowel obstruction: incidence and risk factors of recurrence after surgical treatment: a multicenter prospective study

OBJECTIVE: The aim of the present study was to determine the cumulative incidence and the risk factors of recurrence in patients operated on for an adhesive postoperative small bowel obstruction (SBO). SUMMARY BACKGROUND DATA: Postoperative intraperitoneal adhesions, or bands, resulting from any type of abdominal surgery, are the main cause of adhesive postoperative small bowel obstructions, which represent a life-long issue. Recurrences after operated adhesive postoperative SBO are a threatening potentiality for patients and a difficult problem facing any surgeon. Today the cumulative incidence and the risk factors of recurrence have been retrospectively reported but have never been prospectively evaluated in a multicenter study. METHODS: From January 1997 to January 2002, we enrolled 286 patients operated on for an adhesive postoperative SBO in a prospective multicenter trial. A systematic follow-up was carried out and ended in April 2003. Studied factors for recurrent adhesive postoperative SBO were as follows: age, gender, ASA status, number and sites of previous operations, previous operation for adhesive postoperative SBO, elapsed time from the latest operation, surgical approach, number and type of obstructive structures, site and mechanism of obstruction, final operations, and postoperative surgical and medical complications. They were analyzed using Kaplan-Meier method. A Cox regression model was used to determine the independent risk factor of recurrence. RESULTS: The median follow-up was 41 months (range, 1-75 months). The cumulative incidence of overall recurrence was 15.9%, and for surgically managed recurrence 5.8%. In multivariate analysis, the risk factors for the overall recurrences were age <40 years (hazard ratio [HR], 2.97; confidence interval [CI], 1.48-5.94), adhesion or matted adhesion (HR, 3.79; CI, 1.84-7.78) and, for the surgically managed: adhesions or matted adhesions (HR, 3.64; CI, 1.12-11.84), and postoperative surgical complications (HR, 5.63; CI, 1.73-18.28). CONCLUSION: Operated adhesive postoperative SBO is a clinical entity with a high recurrence rate and specific risk factors of recurrences. Thus, the patients operated on for adhesive postoperative SBO may be candidates for the preventive use of anti-adhesion agents, particularly when a risk factor of recurrence is present.     

Intestinal obstruction from adhesions--how big is the problem?

Apart from one post-mortem study, the incidence of adhesions following laparotomy has not been well documented. 1. In a prospective analysis of 210 patients undergoing a laparotomy, who had previously had one or more abdominal operations, we found that 93% had intra-abdominal adhesions that were a result of their previous surgery. This compared with 115 first-time laparotomies in which 10.4% had adhesions. 2. Over a 25-year period, 261 of 28 297 adult general surgical admissions were for intestinal obstruction from adhesions (0.9%). Of 4502 laparotomies, 148 were for adhesive obstruction (3.3%). 3. Over a 13-year period all laparotomies were followed up for an average of 14.5 months (range 0-91 months). From these 2708 laparotomies, 26 developed intestinal obstruction due to postoperative adhesions within 1 year of surgery (1%). Fourteen did so within 1 month of surgery (0.5%). 4. The majority of the operations producing intestinal obstruction were lower abdominal, principally involving the colon. The volume of general surgical work from adhesions is large and the incidence of early intestinal obstruction is high.     

胃肠道恶性肿瘤术后肠梗阻64例原因分析

为探讨胃肠道恶性肿瘤根治性手术后肠梗阻的原因,对1997年6月至2007年4月手术治疗64例胃肠道恶性肿瘤术后发生肠梗阻的临床资料进行回顾性分析,并分析发生肠梗阻的时间及性质与梗阻原因的关系。结果显示,64例肠梗阻中,肿瘤复发原因占60．9％,良性原因占39．1％。72．0％的良性原因所致肠梗阻发生在术后6个月之内,肿·瘤复发所致的肠梗阻全部出现在术后6个月后。肿瘤局部复发是胃癌和直肠癌术后肠梗阻的主要原因,小肠坠入盆腔粘连成团也是直肠癌术后肠梗阻的重要原因。结果表明,根据初次手术时间结合肿瘤原发部位可大致判断肠梗阻的原因。     

The epidemiology and treatment patterns of postoperative adhesion induced intestinal obstruction in Varsinais-Suomi Hospital District.

BACKGROUND AND AIMS: The epidemiology and treatment patterns of postoperative adhesion induced intestinal obstruction have been poorly investigated in Finland. This study evaluated the epidemiology and treatment patterns of postoperative adhesion induced intestinal obstruction in a well defined geographical area (Hospital District). MATERIAL AND METHODS: All inpatient episodes between 1.1.1999 and 31.12.1999 due to postoperative adhesion induced intestinal obstruction in Varsinais-Suomi Hospital District were evaluated retrospectively using individual patient records. RESULTS: 123 hospitalizations due to postoperative adhesion-related intestinal obstruction were observed during the study period. The total number of preceding operations was 176 considering altogether 101 patients. The most prevalent single initial operations causing adhesion induced intestinal obstruction were colorectal, upper abdominal, and female reproductive system procedures. Of all treatment episodes 32% were operative and mortality was 2%. The median days of hospital stay (range) of all inpatient episodes, operative episodes, and conservative episodes were 6 (1-58), 11 (2-34) and 4 (1-58), respectively. Patient dependent factors associated with increased likelihood to operative treatment of obstruction were: female gender (40% in females vs 23% in males, P = 0.042) and previous gynaecological surgery (70% of the patients, P = 0.032). Intraoperative findings were obstruction in 70%, strangulation in 20%, necrosis in 8%, and perforation in 2% of operations. Bowel resection was needed in 38% of operations. Preceding gynaecological surgery increased the likelihood of bowel strangulation as an intraoperative finding. CONCLUSION: The epidemiology, treatment patterns and results of postoperative adhesion induced intestinal obstruction are of the average international level in the Varsinais-Suomi Hospital District. The treatment patterns among the different hospitals in the Hospital District are similar. Female gender is associated with increased risk for operative treatment of adhesive obstruction. Previous gynaecological surgery increases the likelihood of operative treatment and complicated obstruction.     

Reoperation for small intestinal obstruction

Today, intestinal adhesions represent the most frequent etiology for complete or partial intestinal obstruction. Although partial obstruction can be treated nonoperatively with a considerable likelihood of success, intestinal strangulation cannot uniformly be predicted or prevented. Complete intestinal obstruction is associated with a significant incidence of strangulation if not treated by a vigorous surgical approach. Consequently, complete intestinal obstruction secondary to adhesions is still a surgical disease. Attempts at control of the adhesion process include mechanical methods to prevent subsequent obstruction and chemical methods to prevent the adhesion process itself. The invasive mechanical methods appear dated. A variety of agents have been used either systemically or in the peritoneal cavity to prevent the establishment of intra-abdominal adhesions. Agents that do not contribute to subsequent morbidity or impede the native host defense mechanisms should be utilized. High-molecular-weight dextran and nonsteroidal anti-inflammatory agents show some promise of being both safe and effective. As is frequently the case, the bottom line in preventing and treating intra-abdominal adhesions is appropriate surgical technique. Intestinal adhesions can be related clearly to leaving damaged, devitalized, or ischemic tissue in the peritoneal cavity or to excessive roughness in handling of tissues. Steps such as avoidance of excessive suture material and unnecessary handling of the bowel will do much to prevent subsequent adhesion generation. Likewise, the surgical lysis of intraperitoneal adhesions is frequently fraught with complications such as intra-abdominal abscess or postoperative incisional failure. This is again related to surgical technique and most directly to the use of blunt dissection to divide adhesions. Knife dissection in the lysis of adhesions is recommended. This technique, combined with excellent intraoperative hemostasis, can be associated with a marked diminution in the incidence of postoperative fistulas and abscesses.     

腹腔镜治疗粘连性肠梗阻的临床分析

目的 :比较腹腔镜与开腹手术治疗粘连性肠梗阻的疗效。方法 :将用腹腔镜行肠粘连松解术2 5例临床资料与同期行开腹肠粘连松解术 2 5例的治疗结果进行对照分析。结果 :腹腔镜组与开腹组的手术时间分别为 5 0 2± 13 2min和 136 0± 2 7 9min ,差异有显著性 (P <0 0 1) ;术后使用镇痛药者分别为 4 % (1 2 5 )和 80 % (2 0 2 5 ) ;术后胃肠功能恢复时间分别为 12 3± 4 5h和 4 2 6± 11 2h ,差异有显著性 (P <0 0 1) ;住院时间分别为 6 3± 1 6d和 11 5± 2 8d(P <0 0 1) ;两组均无脏器损伤等严重并发症。腹腔镜组术后随访 2 2例 ,平均随访 30个月 (2～ 36月 ) ,未见复发 ;开腹组术后随访 2 3例 ,平均随访 2 9个月 (2～ 36月 ) ,4例出现肠梗阻复发的症状 ,再次手术治愈。结论 :用腹腔镜行肠粘连松解术安全有效 ,与传统开腹手术比较具有手术时间短 ,患者损伤小 ,切口疼痛轻 ,术后康复快 ,住院时间短等优点     

Leistungsentwicklung eines universitären OP-Bereichs nach Implementierung eines zentralen OP-Managements

The difficult financial situation in German hospitals requires measures for improvement in process quality. Associated increases in revenues in the high income field “operating room (OR) area” are increasingly the responsibility of OR management but it has not been shown that the introduction of an efficiency-oriented management leads to an increase in process quality and revenues in the operating theatre. Therefore the performance in the operating theatre of the University Medical Center Göttingen was analyzed for working days in the core operating time from 7.45 a.m. to 3.30 p.m. from 2009 to 2014. The achievement of process target times for the morning surgery start time and the turnover times of anesthesia and OR-nurses were calculated as indicators of process quality. The number of operations and cumulative incision-suture time were also analyzed as aggregated performance indicators. In order to assess the development of revenues in the operating theatre, the revenues from diagnosis-related groups (DRG) in all inpatient and occupational accident cases, adjusted for the regional basic case value from 2009, were calculated for each year. The development of revenues was also analyzed after deduction of revenues resulting from altered economic case weighting. It could be shown that the achievement of process target values for the morning surgery start time could be improved by 40?%, the turnover times for anesthesia reduced by 50?% and for the OR-nurses by 36?%. Together with the introduction of central planning for reallocation, an increase in operation numbers of 21?% and cumulative incision-suture times of 12% could be realized. Due to these additional operations the DRG revenues in 2014 could be increased to 132?% compared to 2009 or 127?% if the revenues caused by economic case weighting were excluded. The personnel complement in anesthesia (?1.7?%) and OR-nurses (+2.6?%) as well as anesthetists (+6.7?%) increased less compared to the revenues or were slightly reduced. This improvement in process quality and cumulative incision-suture times as well as the increase in revenues, reflect the positive impact of an efficiency-oriented central OR management. The OR management releases due to measures of process optimization the necessary personnel and time resources and therefore achieves the basic prerequisites for increased revenues of surgical disciplines. The method presented can be used by other hospitals as a guideline to analyze performance development.