TY - JOUR
T1 - Effect of Surgical Care Team Consistency During Urologic Procedures on Surgical Efficiency and Perioperative Outcomes
AU - Linder, Brian J.
AU - Anderson, Stephanie S.
AU - Boorjian, Stephen A.
AU - Tollefson, Matthew K.
AU - Habermann, Elizabeth B.
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/5
Y1 - 2023/5
N2 - Objective: To evaluate the effect of urologic surgical care team consistency on surgical efficiency and patient outcomes. Methods: Patients undergoing major urologic surgery (prostatectomy, nephrectomy, or cystectomy) at a single institution from 2010 to 2019 were identified. A surgical care team comprised a certified surgical assistant, certified surgical technologist, and circulating nurse. Primary team member status was assigned on a quarterly basis to team members present for the highest proportion of a surgeon's cases. Surgical efficiency outcomes included time to first incision, procedure duration, and turnover time. Perioperative clinical outcomes included hospital length of stay and 30-day readmission and reoperation rates. Outcomes were compared according to team consistency and assessed via univariate and multivariable analyses. Results: Overall, 11,213 surgical procedures were included. Time to first incision, procedure duration, and turnover time were significantly lower in procedures performed with high-consistency teams (2-3 primary members) versus low-consistency teams (0-1 primary members) (all P <.001). After adjusting for patient-related variables, high-consistency teams were significantly associated with decreased time to first incision (estimate, –2.04 minutes; 95% CI, –2.68 to –1.41 minutes; P <.001) and turnover time (estimate, –7.23 minutes; 95% CI, –9.8 to –4.66 minutes; P <.001). For minimally invasive nephrectomy, high-consistency teams were associated with significantly decreased odds of prolonged hospitalization (odds ratio, 0.63; 95% CI, 0.47-0.84; P = .001). For robotic prostatectomy, high-consistency teams were associated with decreased procedure duration (estimate, –4.55 minutes; 95% CI, –7.48 to –1.62 minutes; P = .002). Conclusion: Highly consistent surgical care teams were associated with improved surgical efficiency and patient outcomes.
AB - Objective: To evaluate the effect of urologic surgical care team consistency on surgical efficiency and patient outcomes. Methods: Patients undergoing major urologic surgery (prostatectomy, nephrectomy, or cystectomy) at a single institution from 2010 to 2019 were identified. A surgical care team comprised a certified surgical assistant, certified surgical technologist, and circulating nurse. Primary team member status was assigned on a quarterly basis to team members present for the highest proportion of a surgeon's cases. Surgical efficiency outcomes included time to first incision, procedure duration, and turnover time. Perioperative clinical outcomes included hospital length of stay and 30-day readmission and reoperation rates. Outcomes were compared according to team consistency and assessed via univariate and multivariable analyses. Results: Overall, 11,213 surgical procedures were included. Time to first incision, procedure duration, and turnover time were significantly lower in procedures performed with high-consistency teams (2-3 primary members) versus low-consistency teams (0-1 primary members) (all P <.001). After adjusting for patient-related variables, high-consistency teams were significantly associated with decreased time to first incision (estimate, –2.04 minutes; 95% CI, –2.68 to –1.41 minutes; P <.001) and turnover time (estimate, –7.23 minutes; 95% CI, –9.8 to –4.66 minutes; P <.001). For minimally invasive nephrectomy, high-consistency teams were associated with significantly decreased odds of prolonged hospitalization (odds ratio, 0.63; 95% CI, 0.47-0.84; P = .001). For robotic prostatectomy, high-consistency teams were associated with decreased procedure duration (estimate, –4.55 minutes; 95% CI, –7.48 to –1.62 minutes; P = .002). Conclusion: Highly consistent surgical care teams were associated with improved surgical efficiency and patient outcomes.
UR - http://www.scopus.com/inward/record.url?scp=85150307902&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85150307902&partnerID=8YFLogxK
U2 - 10.1016/j.urology.2023.02.004
DO - 10.1016/j.urology.2023.02.004
M3 - Article
C2 - 36805413
AN - SCOPUS:85150307902
SN - 0090-4295
VL - 175
SP - 84
EP - 89
JO - Urology
JF - Urology
ER -