Table of Contents
ISRN Surgery
Volume 2012 (2012), Article ID 816871, 5 pages
http://dx.doi.org/10.5402/2012/816871
Research Article

Central Venous Line Placement prior to Gastric Bypass Improves Operating Room Efficiency

1Department of Surgery, The University of North Carolina at Chapel Hill, Campus Box 7081, Chapel Hill, NC 27599, USA
2Department of Radiology, The University of North Carolina at Chapel Hill, Campus Box 7510, Chapel Hill, NC 27599, USA
3Department of Anesthesiology, The University of North Carolina at Chapel Hill, Campus Box 7010, Chapel Hill, NC 27599, USA

Received 14 February 2012; Accepted 19 April 2012

Academic Editors: A. A. Mangi and J. A. Tovar

Copyright © 2012 D. Wayne Overby et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Bariatric surgery has increased across America. Venous access is difficult in these patients. Anesthesiologists often utilize valuable operating room (OR) time acquiring reliable intravenous lines. Our objective was to determine if outpatient central venous line (CVL) placement improves OR efficiency and professional reimbursement for CVL insertion. Methods. In our bariatric practice, selected surgery patients have outpatient CVLs placed during prophylactic vena cava filter placement. In a cohort of 268 gastric bypass patients operated between 1/01 and 11/06, we compared time-to-incision between 106 with pre-established CVLs and 162 without. In addition, we determined professional compensation rates for CVLs placed outpatient versus CVLs inserted in the OR. Results. Patients with preoperative (outpatient) CVLs required 3 5 . 6 ± 1 2 . 5 minutes to skin incision compared with 4 2 . 5 ± 1 3 . 9 minutes for controls ( 𝑃 < 0 . 0 0 0 1 ), and 34.9% had skin incision in <30 minutes compared with 16.4% of controls. Radiologists collected 28.2% of outpatient billings for CPT code 36556, compared with anesthesiologists who collected <1% when placing CVLs in the OR. Conclusions. Outpatient CVLs prior to gastric bypass improve efficiency in the OR with earlier skin incision. Professional reimbursement is better for outpatient CVLs than intraoperative inpatient CVLs.