Does a Dedicated Surgical Team Really Make the Bariatric Surgical Suite More Efficient?

Matthew Fourman, MD, Leena Khaitan, MD. Case Western Reserve University Hospitals

Background
Over the last several years there has been an emphasis on team training in the operating room to improve efficiency and reduce adverse outcomes. A consistent surgical team has been considered particularly important in the care of the patient undergoing bariatric surgery due to the complexity of the surgery and patient comorbidities. Most studies evaluate effect on adverse outcomes. The purpose of this study was to determine whether a dedicated bariatric operative team lead to a more time efficient and cost efficient operating room

Methods
Using the Extuitive cost tracking software, all consecutive bariatric surgical procedures performed by a single surgeon, in the same way, at two separate institutions were reviewed from January 2010 through August 2011. Site A is Tertiary Care, 947 bed teaching hospital with no dedicated operative team and Site B is a rural 150 bed hospital with a dedicated bariatric surgical team. A dedicated team in this study is defined as a consistent nursing and anesthesia staff. All bariatric cases including Laparoscopic Adjustable Gastric Band (LAGB), Laparoscopic Sleeve Gastrectomy (LSG), and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) were reviewed. Revisions and open cases were excluded. All cases were performed with a consistent fellow. Data was collected on patient demographics, operative time, “in room” time and cost of operative supplies. Operative time (OT) is defined as time from incision to placement of dressing. “In room time” (IRT) is total time in the operating room. The difference (DIFF) between the two is set up time before and after the actual procedure. Data was compiled in a database and analyzed using Microsoft Excel software. (p<0.05 considered significant)

Results
A total of 111 cases (59 at Site A, 52 at Site B) were analyzed. At Site A, there were 10 LAGB, 2 LSG, and 47 LRYGB. At Site B, there were 17 LAGB, 5 LSG, and 30 LRYGB. There was no difference in patient demographics or BMI between locations. IRT trended toward being less at Site B (198.4 vs. 182.8 minutes, p=0.06). When comparing IRT by procedure, minimal differences were noted. OT did not differ between sites. When compared by procedure, the set up time (DIFF) was noted to be significantly less at Site B (48 min vs. 40.6 min, p=0.04) for LAGB and for the cases overall (55.6 min vs. 47.1 min, p=0.01). When costs were averaged across all cases, operating room costs were significantly less at Site B ($4,948.91 vs. $6,400.25, p< 0.05). When case types were compared, LRYGB was significantly less expensive at site B ($5,872.34 vs. $6,893.44, p<0.05).

Conclusions
Based upon this data, it appears that bariatric surgical cases can be done in a more time efficient and cost efficient manner with a dedicated operative team.