Authors (including presenting author) :
Man TCS (1), Chen CC (1), Fung SH (1), Wan HY (1), Wong LY (1)
Affiliation :
(1) Department of Cardiothoracic Surgery, Queen Mary Hospital
Keyword 1: :
Positioning method
Keyword 2: :
thoracic surgery
Keyword 3: :
wheels-in-to-incision time
Keyword 4: :
pilot project
Keyword 5: :
cardiothoracic surgery
Keyword 6: :
operating theatre
Introduction :
The wheels-in-to-incision time, i.e. the time from entering the operating theatre (OT) to surgical incision, is usually lengthy for thoracic surgeries due to its complex patient preparation. Optimizing this time interval can enhance patient safety by minimizing patient anaesthetic duration and associated complications while simultaneously improving OT efficiency by increasing surgical capacity.
Objectives :
1. To compare the wheels-in-to-incision time between the conventional and modified patient positioning method for elective thoracic surgeries performed in lateral decubitus position. 2. To evaluate the safety of the modified positioning method by perioperative monitoring and documentation
Methodology :
This quasi-experimental study included patients undergoing elective thoracic surgeries in lateral decubitus positioning, excluding those with severe musculoskeletal deformities or complex comorbidities. One group received conventional positioning, with the dependent arm flexed and placed next to the face and the thoracic cavity hyperextended, creating more working space and better surgical access. In the comparison group, a surgeon with direct observation experience at Shanghai Pulmonary Hospital applied a modified method, placing the dependent arm on a padded arm board without hyperextending the thoracic cavity. Although this provides less surgical space, advancement in equipment and the video-assisted thoracoscopic approach mitigate this limitation. Time metrics and positioning-related complications were recorded for 10 weeks. Independent sample t-test was used for qualitative data analysis.
Result & Outcome :
73 patients were recruited over 10 weeks. 50 patients received conventional positioning with a mean time of 20 minutes (SD=7.81), while 23 used new intervention with a mean time of 15 minutes (SD=7.23). There is a 25% reduction in positioning time (t=1.86, p< 0.05), indicating a substantial improvement. No positioning-related complications were reported. Given that positioning time constitutes only one component of the overall patient preparation process, this finding suggests that similar time saving across other preparatory steps could cumulatively yield a clinically significant shortening of wheels-in-to-incision time. The generalizability of this pilot study is limited, as the new intervention was applied only in a single surgeon’s cases. Furthermore, positioning time is influenced by both surgeons’ and anaesthetists’ preferences. Consequently, the findings may not be directly applicable to other surgeons whose techniques differ.
