日间固定手术团队行减重手术：一项多中心研究分析对患者结局、团队合作和安全氛围以及手术持续时间的影响。

Bariatric surgery with operating room teams that stayed fixed during the day: a multicenter study analyzing the effects on patient outcomes, teamwork and safety climate, and procedure duration.

机构信息

Econometric Institute, Erasmus School of Economics, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.

出版信息

Anesth Analg. 2012 Dec;115(6):1384-92. doi: 10.1213/ANE.0b013e31826c7fa6. Epub 2012 Nov 9.

DOI:10.1213/ANE.0b013e31826c7fa6

PMID:23144431

Abstract

BACKGROUND

Bariatric surgery durations vary considerably because of differences in surgical procedures and patient factors. We studied the effects on patient outcomes, teamwork and safety climate, and procedure durations resulting from working with operating room (OR) teams that remain fixed for the day instead of OR teams that vary during the day.

METHODS

Data were collected in 2 general teaching hospitals, consisting of patientrelated demographic and intraoperative data and of staffrelated survey data on team work and safety climate. The procedure durations of fixed and conventional OR teams were analyzed by comparison of means tests and by regression methods to control for the effects of surgeon, surgical experience, and procedure type.

RESULTS

For both hospitals, we obtained the following 4 results for working on bariatric procedures with OR teams that remained fixed for the day. First, patient outcomes did not worsen. Second, teamwork and safety climate (both measured on a 5-point scale) improved significantly, for teamwork + 0.86 (95% confidence interval [CI], 0.54 to 1.18) and for safety climate + 0.75 (95% CI, 0.40 to 1.11). Third, the procedures were performed significantly faster, as both the mean and the SD of procedure durations decreased. After correcting for learning effects, the average reduction of durations was 10.8% (99% CI, 5.0% to 15.3%, or 4 to 13 minutes). This gain was mainly realized for surgical time (12%; 99% CI, 5% to 18%, or 3 to 11 minutes). The effect on peripheral time, defined as procedure time minus surgical time, is not significant (3%; 99% CI, -6% to 12%, or -1 to 3 minutes). Fourth, additional gains were obtained by performing the same type of procedure multiple times within the same day (5% per every next procedure of the same type; 99% CI, 3% to 7%, or 3 to 6 minutes).

CONCLUSIONS

Working with fixed teams in bariatric surgery reduced procedure durations and improved teamwork and safety climate, without adverse effects on patient outcomes.

摘要

背景

减重手术的持续时间因手术程序和患者因素的差异而有很大差异。我们研究了与手术室（OR）团队合作对患者结局、团队合作和安全氛围的影响，这些团队在一天中保持不变，而不是在一天中变化的 OR 团队。

方法

数据来自 2 家普通教学医院，包括与患者相关的人口统计学和术中数据以及与工作人员相关的团队合作和安全氛围调查数据。通过均值检验和回归方法分析固定和常规 OR 团队的手术程序持续时间，以控制外科医生、手术经验和手术类型的影响。

结果

对于这两家医院，我们在与手术室团队合作时获得了以下 4 个结果，这些团队在一天中保持不变。首先，患者结局没有恶化。其次，团队合作和安全氛围（均以 5 分制衡量）显著改善，团队合作+0.86（95%置信区间[CI]，0.54 至 1.18）和安全氛围+0.75（95%CI，0.40 至 1.11）。第三，手术程序明显更快，因为手术程序持续时间的平均值和标准差都降低了。在纠正学习效应后，持续时间的平均减少率为 10.8%（99%CI，5.0%至 15.3%，或 4 至 13 分钟）。这一收益主要来自手术时间（12%；99%CI，5%至 18%，或 3 至 11 分钟）。对定义为手术时间减去手术时间的外围时间的影响并不显著（3%；99%CI，-6%至 12%，或-1 至 3 分钟）。第四，在同一天内多次进行相同类型的手术可以获得额外的收益（每次相同类型的下一个手术增加 5%；99%CI，3%至 7%，或 3 至 6 分钟）。