Surgical team familiarity may decrease operating time

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1. Surgical teams with more than 10 prior collaborations had significantly shorter operative time, compared to teams with no prior collaborations.

2. The range of operative times was also shorter for teams with more than 10 prior collaborations, compared to teams with no prior collaborations.

Evidence Rating Level: 2 (Good)

Study Rundown: The emphasis of the collaborative team environment in medicine is thought to improve patient outcomes. There are interventions intended to improve communication between team members, such as checklists and timeouts, which have been shown to reduce errors in the operating room. This study examines familiarity between surgical team members and its effect on operative time in bilateral reduction mammoplasties. It was demonstrated that mean operative times were shorter with surgical teams where the attending surgeon and the assisting surgeon had more prior collaborations.

Limitations of the study include the retrospective nature of the study, as outside biases cannot be accounted for. Moreover, the study only examines collaborations between the attending surgeon and the assisting surgeon, not considering other operating room staff. The study only examined one particular procedure at a single tertiary academic center. Therefore, results may not be generalizable to a wider population. Finally, the only significant outcome was reduction in skin-to-skin time, whereas no significant improvement was found in postoperative complications or patient satisfaction with outcome.

Click to read the study in Annals of Surgery

Relevant Reading: Teamwork and error in the operating room: analysis of skills and roles

In-Depth [retrospective study]: This study retrospectively examined 754 bilateral reduction mammoplasty procedure performed at a single academic tertiary care center. The operative experience in years of the attending surgeon (years since completion of training) and the assisting surgeon (years since beginning of residency) were calculated, and the cumulative number of reduction mammoplasties performed by the same two surgeons in collaboration before a given procedure was calculated. A total of 223 teams of attending and assisting surgeons were analyzed, comprising of 8 attending surgeons and 107 assisting surgeons.

The mean operative time was 153 minutes for of teams with no prior collaborations, 132 minutes for teams with 1 to 5 prior collaborations, 116 minutes for teams with 6 to 10 prior collaborations, and 119 minutes for teams with more than 10 prior collaborations (P=0.0001). Moreover, the range of operative times was smaller for teams with greater numbers of collaborations. Shorter operative times were also associated with greater experience of both the attending and assisting surgeons (P=0.02 and P=0.03). No significant difference in number of complications or patient satisfaction with outcome was found.

By James Jiang and Allen Ho

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