Comparison of Perioperative and Procedure Room Times Between Moderate Sedation and Monitored Anesthesia Care in Interventional Radiology

Wednesday, March 8, 2023

3:09 PM – 3:18 PM

Location: Phoenix Convention Center, 222C

Presenting Author(s)

Vlasios S. Sotirchos, MD

Assistant Attending
Memorial Sloan Kettering Cancer Center

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Chenyang Zhan, MD PhD

Assistant Attending
Memorial Sloan Kettering Cancer Center
Leila Haghani, MD

Research Fellow
Memorial Sloan Kettering Cancer Center
KZ

Ken Zhao, MD

Assistant Attending
Memorial Sloan Kettering Cancer Center
EA

Erica S. Alexander, MD (she/her/hers)

Assistant Attending
Memorial Sloan Kettering Cancer Center
LJ

Liwei Jiang, MD

Assistant Attending
Memorial Sloan Kettering Cancer Center
Brett Marinelli, MD

Assistant Attending
Memorial Sloan Kettering Cancer Center
MS

Mikhail Silk, MD

Assistant Attending
Memorial Sloan Kettering Cancer Center
HY

Hooman Yarmohammadi, MD

Associate Attending
Memorial Sloan-Kettering Cancer Center
EZ

Etay Ziv, MD PhD

Associate Attending
Memorial Sloan Kettering Cancer Center
Constantinos T. Sofocleous, MD PhD

Professor IR
Weill Cornell Medical College Memorial Sloan-Kettering Cancer Center
SS

Stephen B. Solomon, MD

Section Chief
Memorial Sloan Kettering Cancer Center
JE

Joseph P. Erinjeri, MD PhD

Attending
Memorial Sloan Kettering Cancer Center

Disclosure(s):

Vlasios S. Sotirchos, MD: No financial relationships to disclose

Leila Haghani, MD: No financial relationships to disclose

Ken Zhao, MD: No financial relationships to disclose

Erica S. Alexander, MD: No financial relationships to disclose

Etay Ziv, MD PhD: Ethicon J&J: Research Grant Recipient (Ongoing); Novartis Pharmaceuticals Corporation: Research Grant Recipient (Ongoing)

Constantinos T. Sofocleous, MD PhD: No relevant disclosure to display

Stephen B. Solomon, MD: Aperture Medical: Board Membership (Ongoing), Consultant (Ongoing), Ownership Interest (Ongoing); Elesta: Research Grant Recipient (Ongoing); GE Healthcare: Consultant (Ongoing), Research Grant Recipient (Ongoing); Johnson & Johnson: Consultant (Ongoing), Ownership Interest (Ongoing); Microbot: Consultant (Ongoing); XAct Robotics: Consultant (Ongoing)

Purpose: Most interventional radiology (IR) departments offer nurse-administered moderate sedation (MOSED) for the majority of procedures. In recent years, there has been increased utilization of monitored anesthesia care (MAC) in IR. The purpose of this study was to evaluate pre-operative, procedure room, post-operative times for IR procedures performed with MOSED and MAC.

Materials and Methods: An IRB-approved retrospective review of IR procedures was performed between January 2010 and September 2022. Procedures and scheduling times for procedures performed with MOSED and MAC were extracted from the Epic Optime module. Procedures performed with general anesthesia or local, missing time stamps, or where less than 50 cases were performed for both MAC and MOSED were excluded. Pre-operative time (time in pre-surgical bed), procedure room time, post-operative time (time in PACU bed), as well as total patient time in IR, were compared between MAC and MOSED cases using the t-test (significance p< 0.05). Given the large sample size which can overestimate significance, the effect size was estimated using Cohen’s d statistic (mean difference/pooled standard deviation); large effects were defined as d > 0.8, moderate 0.5-0.8, and small < 0.5.

Results: 102744 cases spanning 69 procedure codes were examined. The most commonly performed procedures were chest port placement (16%), lung biopsy (12%), liver biopsy (6%), abdomen biopsy (5%) and chest port removal (4%). Pre-operative times showed a large increase for MAC procedures compared to MOSED (27 mins, 69 vs 42, p< 0.0001, d=0.95), including chest port placement (68 vs 41 min), lung biopsy (75 vs 44 min), liver biopsy (70 vs 43 min), abdomen biopsy (69 vs 41 min) and chest port removal (63 vs 39 min), all p< 0.001. When comparing MAC to MOSED cases, there was a small decrease in procedure room times (-11 min, 60 vs 71, p< 0.0001, d=-0.48) and a small increase in post-operative times (10 mins, 102 vs 92 min, p< 0.0001, d=0.22). Overall, total patient time in IR was 27 mins greater for MAC cases than MOSED cases (231 vs 204 mins, p< 0.001), and was most pronounced for biliary catheter to stent conversions (282 vs 241 min), placement of nephroureterostomy (266 vs 230 min) and IVC filter removal (214 vs 179 min), all p< 0.001.

Conclusion:
Compared to MOSED, procedures performed with MAC decrease procedure room time, at the expense of increased pre-operative, post-operative, and total patient time in IR.