Department of Orthopaedic Surgery, Stanford Health Care, Stanford, California.
Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California.
JAMA Surg. 2023 Jun 1;158(6):603-608. doi: 10.1001/jamasurg.2023.0168.
Surgical team communication is a critical component of operative efficiency. The factors underlying optimal communication, including team turnover, role composition, and mutual familiarity, remain underinvestigated in the operating room.
To assess staff turnover, trainee involvement, and surgeon staff preferences in terms of intraoperative efficiency.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of staff characteristics and operating times for all total joint arthroplasties was performed at a tertiary academic medical center by 5 surgeons from January 1 to December 31, 2018. Data were analyzed from May 1, 2021, to February 18, 2022. The study included cases with primary total hip arthroplasties (THAs) and primary total knee arthroplasties (TKAs) comprising all primary total joint arthroplasties performed over the 1-year study interval.
Intraoperative turnover among nonsurgical staff, presence of trainees, and presence of surgeon-preferred staff.
Incision time, procedure time, and room time for each surgery. Multivariable regression analyses between operative duration, presence of surgeon-preferred staff, and turnover among nonsurgical personnel were conducted.
A total of 641 cases, including 279 THAs (51% female; median age, 64 [IQR, 56.3-71.5] years) and 362 TKAs (66% [238] female; median age, 68 [IQR, 61.1-74.1] years) were considered. Turnover among circulating nurses was associated with a significant increase in operative duration in both THAs and TKAs, with estimated differences of 19.6 minutes (SE, 3.5; P < .001) of room time in THAs and 14.0 minutes (SE, 3.1; P < .001) of room time in TKAs. The presence of a preferred anesthesiologist or surgical technician was associated with significant decreases of 26.5 minutes (SE, 8.8; P = .003) of procedure time and 12.6 minutes (SE, 4.0; P = .002) of room time, respectively, in TKAs. The presence of a surgeon-preferred vendor was associated with a significant increase in operative duration in both THAs (26.3 minutes; SE, 7.3; P < .001) and TKAs (29.6 minutes; SE, 9.6; P = .002).
This study found that turnover among operative staff is associated with procedural inefficiency. In contrast, the presence of surgeon-preferred staff may facilitate intraoperative efficiency. Administrative or technologic support of perioperative communication and team continuity may help improve operative efficiency.
手术团队的沟通是手术效率的关键组成部分。在手术室中，最佳沟通的基础因素，包括团队更替、角色组成和相互熟悉程度，仍未得到充分研究。
评估员工更替、实习生参与情况以及外科医生对手术效率的满意度。
设计、地点和参与者：对 2018 年 1 月 1 日至 12 月 31 日在一家三级学术医疗中心的所有全关节置换术的工作人员特征和手术时间进行回顾性分析，由 5 名外科医生进行。数据分析于 2021 年 5 月 1 日至 2022 年 2 月 18 日进行。该研究包括原发性全髋关节置换术（THA）和原发性全膝关节置换术（TKA）的病例，涵盖了研究期间所有原发性全关节置换术。
非手术人员的术中更替、实习生的存在以及外科医生偏好的工作人员的存在。
每个手术的切口时间、手术时间和房间时间。对手术持续时间、外科医生偏好的工作人员的存在以及非手术人员更替之间的关系进行多变量回归分析。
共考虑了 641 例病例，包括 279 例 THA（51%为女性；中位年龄 64 [IQR，56.3-71.5] 岁）和 362 例 TKA（66%为女性[238 例]；中位年龄 68 [IQR，61.1-74.1] 岁）。巡回护士的更替与 THA 和 TKA 手术时间的显著增加相关，THA 的房间时间估计差异为 19.6 分钟（SE，3.5；P < .001），TKA 的房间时间差异为 14.0 分钟（SE，3.1；P < .001）。麻醉师或外科技术员的存在与 TKA 的手术时间分别显著减少 26.5 分钟（SE，8.8；P = .003）和房间时间减少 12.6 分钟（SE，4.0；P = .002）有关。外科医生偏好的供应商的存在与 THA（26.3 分钟；SE，7.3；P < .001）和 TKA（29.6 分钟；SE，9.6；P = .002）的手术时间显著增加相关。
本研究发现手术人员更替与程序效率低下有关。相比之下，外科医生偏好的工作人员的存在可能有助于提高手术效率。围手术期沟通和团队连续性的行政或技术支持可能有助于提高手术效率。
