Clinical surgery-American
Surgical time independently affected by surgical team size

https://doi.org/10.1016/j.amjsurg.2008.10.016Get rights and content

Abstract

Background

Team size and composition provide essential data for the study of operating room (OR) efficiency.

Methods

Laparoscopic procedures between July 2005 and July 2007 were reviewed retrospectively to record the number of OR personnel and the procedure time (PT).

Results

Of 399 procedures reviewed, 360 cases with complete data were analyzed. The average PT was 148 minutes. A mean of 8 different team members (range, 4–15) were involved. Surgeons and anesthesiologists stayed constant whereas the OR nurses were replaced more than once per procedure (mean, 4 nurses/procedure; range, 2–11). Multiple regression analysis revealed that both complexity of surgery and team size affected the PT significantly. When procedure complexity and patient condition were held constant, we found that adding 1 individual to a team predicted a 15.4-minutes increase in PT.

Conclusions

The surgical team is a dynamic system with a large amount of member turnover. Efforts to improve OR efficiency should focus on decreasing surgical team size, limiting staff turnover, and enhancing communication between team members.

Section snippets

Procedures

A retrospective case review was completed on all general laparoscopic procedures that were preformed by the senior author (L.L.S.) between July 2005 and July 2007. Procedures were performed in 3 ORs designed for minimally invasive surgical procedures. Ethical approval was obtained from the Internal Review Boards at Legacy Health System (FWA00001280) and Providence Portland Medical Center (07 A–88 A).

Data collection

From the intraoperative nursing records we recorded surgeons, surgeon assistants,

Results

A total of 399 cases were reviewed retrospectively. Laparoscopic procedures performed included cholecystectomy, hernia repair, various surgical procedures for gastroesophageal reflux disease, bariatric procedures, esophagectomy, and other general surgery procedures. Thirty-nine procedures were deleted from the analysis because of incomplete surgical records, such as missing procedure time, OR staff, or lack of OR report. The analysis was performed on 360 procedures.

Comments

On average, 8 people were assigned to a 2.5-hour laparoscopic procedure in the hospitals studied. When we categorized the role of each team member, we found that the anesthesiologists and surgeons assigned to a procedure normally stayed for the entire surgery; however, the nurses often shifted their duties for varied reasons such as lunch, shift change, and coffee breaks. We found that the 2 nursing roles (scrub nurse and circulating nurse) were replaced more than once for each surgical

Conclusions

In this study, we have described the size and the composition of surgical teams for laparoscopic procedures. We found that each addition to the OR team significantly increased the PT independent of other factors. Understanding the surgical team size and composition will allow us to design better educational tools for improving team composition and communication, and to develop better management strategies to optimize surgical teams and facilitate OR efficiency. Efforts to improve OR efficiency

Acknowledgments

The authors would like to thank Dr. Michael B. Ujiki, Dr. Tayyab S. Diwan, Dr. Georg O. Spaun, Dr. Yashodhan Khajanchee, Dr. Paul D. Hansen, and Dr. Alan Lomax for providing feedback during preparation of the manuscript.

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