Pasquer Arnaud, Ducarroz Simon, Lifante Jean Christophe, Skinner Sarah, Poncet Gilles, Duclos Antoine
Research On Healthcare Performance RESHAPE, Université Claude Bernard, Inserm U1290, Lyon 1, France.
Department of Digestive and Colorectal Surgery, Edouard Herriot University Hospital, 5 Place d' Arsonval, 69003, Lyon, France.
Patient Saf Surg. 2024 Jan 29;18(1):5. doi: 10.1186/s13037-023-00388-3.
Organizational factors may influence surgical outcomes, regardless of extensively studied factors such as patient preoperative risk and surgical complexity. This study was designed to explore how operating room organization determines surgical performance and to identify gaps in the literature that necessitate further investigation.
We conducted a systematic review according to PRISMA guidelines to identify original studies in Pubmed and Scopus from January 1, 2000 to December 31, 2019. Studies evaluating the association between five determinants (team composition, stability, teamwork, work scheduling, disturbing elements) and three outcomes (operative time, patient safety, costs) were included. Methodology was assessed based on criteria such as multicentric investigation, accurate population description, and study design.
Out of 2625 studies, 76 met inclusion criteria. Of these, 34 (44.7%) investigated surgical team composition, 15 (19.7%) team stability, 11 (14.5%) teamwork, 9 (11.8%) scheduling, and 7 (9.2%) examined the occurrence of disturbing elements in the operating room. The participation of surgical residents appeared to impact patient outcomes. Employing specialized and stable teams in dedicated operating rooms showed improvements in outcomes. Optimization of teamwork reduced operative time, while poor teamwork increased morbidity and costs. Disturbances and communication failures in the operating room negatively affected operative time and surgical safety.
While limited, existing scientific evidence suggests that operating room staffing and environment significantly influences patient outcomes. Prioritizing further research on these organizational drivers is key to enhancing surgical performance.
组织因素可能会影响手术结果，无论诸如患者术前风险和手术复杂性等因素是否已得到广泛研究。本研究旨在探讨手术室组织如何决定手术表现，并找出文献中需要进一步研究的空白。
我们根据PRISMA指南进行了系统回顾，以识别2000年1月1日至2019年12月31日期间发表在PubMed和Scopus上的原始研究。纳入评估五个决定因素（团队组成、稳定性、团队合作、工作安排、干扰因素）与三个结果（手术时间、患者安全、成本）之间关联的研究。根据多中心调查、准确的人群描述和研究设计等标准评估方法。
在2625项研究中，76项符合纳入标准。其中，34项（44.7%）研究了手术团队组成，15项（19.7%）研究了团队稳定性，11项（14.5%）研究了团队合作，9项（11.8%）研究了工作安排，7项（9.2%）研究了手术室干扰因素的发生情况。外科住院医师的参与似乎会影响患者的手术结果。在专用手术室中采用专业且稳定的团队可改善手术结果。团队合作的优化可减少手术时间，而不良的团队合作会增加发病率和成本。手术室中的干扰和沟通失败对手术时间和手术安全产生负面影响。
虽然现有科学证据有限，但表明手术室人员配备和环境会显著影响患者的手术结果。优先对这些组织驱动因素进行进一步研究是提高手术表现的关键。
