The Impact of Surgical Team Size on Laparoscopic Surgical Performance

Introduction: The surgical team is a dynamic system with constant change in tasks and team composition. This study reviewed operation records retrospectively to describe the surgical team composition, and examine the impact of surgical size on performance. We aim to improve the OR efficiency by constructing optimal surgical teams.
Methods: Cases preformed by an expert laparoscopic surgeon between July 2005 and July 2007, were reviewed at two hospitals of Legacy Health System. For each case, the attendee number and procedure time were extracted from the intraoperative nursing records; the role of each attendee was categorized.
Results: Two-hundred cases were reviewed and 19 incomplete data cases were excluded for further analysis. The average procedure time of 181 valid cases was 144 ± 88 min. Cases included a wide range of general surgical procedures performed laparoscopically. On average, 8.3 team members were involved with each case, which was higher than expected. The majority of surgeries (178 cases, 99%) were supervised by one anesthesiologist. Only 10 cases (5%) were performed by one surgeon. Most of the cases were performed by two (105, 59%) or three surgeons (60, 33%). More nurses were involved in a surgery in comparison to surgeons and anesthesiologists. On average, 4.1 (range 2-7) nurses were assigned to each case. The nurse shifting was due to numerous reasons, and most shifting occurred during lunch time. In addition to the core team members, a small number of staff (mean = 0.8) was present in the OR providing specific assistance or observing the surgery.
The number of team members was correlated positively with the procedure time (Pearson’s r = 0.45). Specifically, the procedure time was prolonged as the number of team members increased. To search for causal relationship between the team composition and procedure time, the data was grouped according to the procedure starting time. Cases started at lunch time (10am-2pm) had higher nurse shifting number (4.6) and longer procedure time (152.1 min) than those cases started before (4.1 shift changes, 140.1 min) or after lunch time (3.9 shift changes, 134.1 min).
Conclusion: This study provides quantitative descriptions on team composition and demonstrates clearly that a frequent change of core team members had a measurable impact on surgical performance. This result calls for optimal OR management strategies, better team collaboration, and communication in order to improve OR efficiency.

Session: Poster

Program Number: P160

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