RCOG World Congress 2025

Improving theatre utilisation in Gynaecology:

Evidence-based guidelines for estimating operating times

Dr R Hodges, Dr U Mbaba, Dr I Cameron

Objective:

The aim of this project was to develop guidance for theatre times for common gynaecological operations.

Despite a national target of 85% theatre utilisation recommended by NHSE (Getting it right first time n.d.), no standardised local guidelines currently exist for estimating operating times in gynaecology, which are used to populate theatre lists, leading to wide variation of between 50% and 90% theatre utilisation within our department. By providing evidence-based recommendations, we hope to reduce variation and improve theatre efficiency.

Design:

This was a retrospective study used to assess accuracy of estimated times when compared to actual theatre time.

Additionally, we studied the relationship between BMI and operative times. The study included 506 procedures between October 2023 and March 2024.

Results

17 types of procedure were included in the data set, of which, as a trust we were only accurately estimating theatre time in 5 of them (29.4%). (Figure 1)

As a trust, 47.1% of the time we were overestimating theatre time, meaning wasted theatre capacity as lists were being completed earlier than estimated. When this is the case, there is the potential for more cases to be on a list, directly reducing waiting lists.

Of the remaining 23.5%, the department was underestimating times, meaning lists ran over scheduled theatre time increasing the risk of staff burnout and the potential last minute case cancellation due to the schedule. This directly impacts patient safety and waiting lists.

Our results showed poor estimation across all procedure types (laparotomy, laparoscopy, hysteroscopy and vaginal repair) with no area of strength in estimating anticipated theatre times.

Despite 75% of the patients in the data set having a BMI >25, procedure length was only impacted by BMI in two procedures : Total Laparoscopic Hysterectomy with Bilateral Salpingoopherectomy and Laparoscopic Bilateral Salpingoopherectomy. (Figure 2)

Methodology

The data was collected from the electronic patient flow record and included:

Anticipated theatre time (anaesthetic and operative time) from theatre booking forms completed by the gynaecology team.
BMI from pre- assessment documentation
Total Theatre Time (time of anaesthetic induction to arrival in Recovery) from electronic theatre record

Data was separated into procedure type (laparoscopic, open, hysteroscopic etc.). Mean averages were calculated for BMI ranges for procedures.

Our results were then the basis of an evidence-based guideline for the gynaecology team to use when booking procedures. If there was evidence of variation in time depending on BMI that was significant, we ensured our guidance on anticipated timings reflected that.

Conclusions

The lack of standardised guidelines for anticipated operation times is contributing to suboptimal theatre usage which affects patient care and waiting lists. Currently, estimated times are provided by clinicians in clinic when they add patients to a waiting list- junior clinician's may not be familiar with the average procedure duration.

75% of patients in the study had a BMI >25 and whilst this did not affect all procedure lengths- it must be considered in Laparoscopic Procedures.

Therefore, our evidence suggests that a guideline based on trust specific data will help streamline theatre usage. (Figure 3)

RCOG World Congress 2025

Improving theatre utilisation in Gynaecology: Evidence- based guidelines for estimating operative times

Poster Presenter

Authors

Affiliations

Part of Topic