[What does one need to optimize the suture to turnover time?]

The suture to incision time (turnover time, TOT) is a key indicator of the efficiency of perioperative care and reflects the quality of numerous preceding organizational and logistical processes. In the field of visceral surgery optimizing the turnover time poses particular challenges due to the highly variable duration of procedures, complex surgical workflows and substantial requirements for postoperative intensive monitoring capacities. This narrative review summarizes the factors described in the literature as having a relevant influence on turnover time. These include patient flow from the wards to the operating theater, operating room preparation including material and equipment availability, suitable staffing and infrastructural resources as well as the integration of unplanned interventions, such as emergencies, revision procedures and transplantations. Furthermore, organizational strategies are presented that in various studies were found to be associated with an improvement in perioperative workflows, including standardized turnover processes, lean-based approaches, parallel task execution and digital support systems. Finally, the review discusses the role of operating room management that can be centralized, decentralized or as hybrid model depending on the local structure, with a focus on coordination, prioritization and the establishment of reliable communication pathways.