R. Mallonee1, S. Parker3, A. Tegge2, S. Safford1 1Virginia Tech Carilion School of Medicine,Surgery,Roanoke, VA, USA 2Virginia Tech,Statistics,Blacksburg, VA, USA 3Carilion Clinic,Human Factors,Roanoke, VA, USA
Introduction:
Longer operative durations have been linked to higher complication rates, longer hospital stays, and increased infection risk. System-based approaches have identified systems-factors external to the patient/surgeon that influence duration. One factor of interest is team familiarity. In multiple settings, greater familiarity between attending/ assisting surgeon has been associated with decreased operative times. However, little research has considered familiarity across the entire team, including team members such as anesthetist, circulator, or surgical technician. Further work is needed to appreciate the importance of familiarity in determining operative time.
Methods:
Retrospective analysis of 98 colectomies performed by 15 surgeons at Roanoke Memorial Hospital and New River Valley Medical Center from 2011-2016. Cases were selected from larger sample of 645 colectomies based on -1SD from mean operative time. Linear mixed-effects models (LMEM) were used to identify interactions between systems factors and duration. Factors included patient factors (age, BMI, gender, race, procedure type, ASA score, and wound class) and external factors (night surgery, facility, day-of-week, month, and cumulative dyadic familiarity scores). Physician ID acted as random effect to accommodate surgeon-specific differences in speed. Cumulative dyadic familiarity scores were calculated via summed number of cases worked together in each dyad of physician, anesthetist, circulator, and surgical tech.
Results:
For initial sample of 645 cases, mean operative duration was 141.9 min and mean familiarity score was 335.1 (range: 1-2650). For initial sample of 645 cases, operative duration was not correlated with cumulative familiarity (p=0.82 via Kendall rank correlation). For identified faster cases(-1SD below the mean), mean operative time was 74.1min and mean familiarity score was 361.7 (range: 1-2567). Faster cases was associated with cumulative dyad familiarity (-0.011min/point of familiarity, p=0.037) and female gender of the patient (-9.17min, p=0.04) and year the operation was performed as significant predictors of operative time.
Conclusion:
System factors, including familiarity and patient gender and year of the operation influence operative time. Familiarity between key members of the surgical team has a statistically significant impact on colectomy operative time, but the clinical meaningfulness of this indicator alone requires further study. Further research is necessary to understand whether this finding is consistent across additional types of operations and health systems.