Presentation (CTI)

OBJECTIVES: Operating room (OR) efficiency and predictability are key drivers of hospital resource utilization and surgical throughput. Although carotid endarterectomy (CEA) has been the standard for carotid revascularization, it is associated with longer and more variable operative times than transcarotid artery revascularization (TCAR). To understand the operational implications of these differences, this study modeled the potential impact of TCAR versus CEA on daily OR throughput and annual vascular surgeon case volume.
METHODS: A deterministic procedural efficiency model was developed using published Vascular Quality Initiative data (Columbo et al., 2022) and clinical expert and literature-informed inputs for TCAR and CEA. Parameters included a 7:30AM-5:00PM block schedule (with 30-minute lunch), 30-minute anesthesia time, and 30-minute turnover, per case. Vascular surgeons were assumed to have 144 OR days annually (3 days/week, 48 weeks/year). Operative times were modeled using median (interquartile range [IQR; 25th-75th percentile]) values of 66 (51-85) minutes for TCAR and 110 (86-139) for CEA. Scenarios included a base case, a “faster” day (25th percentile operative time, 20% shorter turnover), and a “slower” day (75th percentile operative time, 20% longer turnover).
RESULTS: Base case total cycle time (operative+anesthesia+turnover) was 126 minutes for TCAR and 170 minutes for CEA (-44 minutes difference), enabling 4 versus 3 full cases daily, respectively. Across scenario analyses, TCAR supported 1-2 additional full cases daily, resulting in approximately 144-288 additional cases annually per vascular surgeon. The operative time IQR was 34 minutes for TCAR and 53 minutes for CEA, a 35.8% narrower spread for TCAR, indicating more predictable scheduling.
CONCLUSIONS: TCAR’s shorter, more consistent OR time may improve OR predictability and enable 144-288 additional cases annually per surgeon relative to CEA. From a hospital perspective, the associated increase in effective OR capacity can be redeployed to additional TCAR procedures or other urgent, high-priority cases, enhancing patient access and economic value.