Changing team members affect procedure times in both open and laparoscopic procedures

Bin Zheng, MD, PhD, Lee L Swanstrom, MD, Terry Phang, MD, O. M. Neely Panton, MD

University of Alberta

Background: We previously reported that operative procedure times for laparoscopic surgery were prolonged by changes in operative team members (nursing shift changes and resident staff). In this study we ask whether operative procedure times are affected by changes overs in operative team members are the same for open and laparoscopic surgeries of comparable complexity.

Methods: Medical charts of surgical procedures performed by three faculty surgeons at five tertiary hospitals located in three US and Canadian cities were reviewed over a period of one calendar year. Cases included open and laparoscopic procedures. For each case performed by these surgeons, the procedure type, surgical team members, and procedure time were extracted with patient demographics from the intra-operative nursing records. The procedure complexity was assessed by a previously validated calculated index for measuring procedure complexity. Multiple logistic regressions were performed separately for open and laparoscopic procedures to assess the impact the team size had on the procedure time after adjusting for procedure complexity, patient age, and ASA scores.

Results: A total of 1263 cases were reviewed, composed of 333 open and 930 laparoscopic surgeries. The mean complexity index were 18 for the open and 34 for laparoscopic procedures; the mean procedure times were 54 minutes for open and 123.7 min for laparoscopic. On average, open procedures involved 7 members while laparoscopic had 8 members participating. Multiple regression analysis revealed that the complexity of the procedure and the team size both affected the intra-operative procedure time significantly for both the open and laparoscopic procedures. When the complexity of the procedure and patient condition were held constant, we found that adding one individual to an open surgical team predicted a 13-minute increase in the procedure time; whereas in laparoscopic team, one member change predict a 10-minute increase in the procedure time.

Discussion: This study provides a quantitative analysis of team composition and clearly demonstrates that frequent changes of core team members have a measurable and negative impact on the surgical time for both open and laparoscopic procedures. These results support the need to optimize operating room management strategies; specially better team management (i.e., designated staffing), and better intra-team communication in order to improve efficiency in the operating room.

Session: Poster Presentation

Program Number: P602

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