Clayton C Petro, MD, Wanda Lam, MD, Adel A Saleh, MD, Gi Yoon Kim, Leena Khaitan, MD, FACS. University Hospitals Cleveland Medical Center
INTRODUCTION: Operating room(OR) efficiency is the culmination of coordinated care between the staff surgeon, anesthesia team, circulating nurse, surgical tech, and surgical trainee/assistant. Bariatric cases present challenges to all team members in regards to difficult airways, challenging intravenous access, use of specialized stapling devices, and synchronized exchange of orogastric tubes. The high contribution margin of these complex bariatric procedures rests on their OR efficiency. Many studies have shown improved efficiency in the OR with standardized surgical teams. We hypothesized that the efficiency of a single surgeon and assistant would be negatively affected by the inherent variability of OR staff and teaching that takes place at a tertiary academic medical center when compared to a private hospital with a standardized surgical team.
METHODS: Laparoscopic Roux-en-Y gastric bypasses (LRYGB) during a similar time period (2013-2015) at University Hospitals Cleveland Medical Center (UHCMC) were compared to those done at a Community Affiliate (CA). All operations were done by a single surgeon with a surgical fellow, and the operative hospital was typically dictated by insurance, not patient complexity. Patient demographics, comorbidities, and operating room times were compared using standard statistical methods
RESULTS: A total of 79 LRYGB were done at UHCMC, while 255 were done at the CA. Patient cohorts were comparable by age (45±12;46±12), BMI (48±8;45±8), and comorbidity rates. Standardized surgical teams were used at the CA during the study period, but at no time were implemented at UHCMC. The mean time from the patient entering the operating room until the case starting was 39 min at UHCMC, compared to 32 min at the CA(p<0.0001). The mean case duration was 151 minutes at UHCMC and 149min at the CA(p=0.78). The mean time from the end of the case until the patient was out of the room was 13 min at UHCMC and 12 minutes at the CA(p=0.48). Mean total OR time was 203 minutes at UHCMC and 195 minutes at the CA(p=0.20).
CONCLUSION: Bariatric surgery, though challenging for all operating room staff, can be done proficiently at a tertiary academic medical center with variable operating room staff when compared to a private hospital setting with a standardized surgical team. In this study the surgeon and assistant remained constant, which may have facilitated the efficiency in the OR. High staff variability and teaching in an academic setting did not have the anticipated negative effect on operating room efficiency.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87772
Program Number: S108
Presentation Session: Residents/Fellows Session
Presentation Type: ResFel