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Surgical team composition has a major impact on effectiveness and costs in laparoscopic donor nephrectomy

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Abstract

Purpose

Limited evidence exists that optimization of surgical team composition may improve effectiveness of laparoscopic donor nephrectomy (LDN).

Methods

A retrospective cohort study with 541 consecutive LDNs. From 2003 to 2012, surgical team composition was gradually optimized with regard to the surgeons’ experience, proficient assistance and the use of fixed teams.

Results

Multivariable analysis showed that a surgical team with an experienced surgeon had a significantly shorter operation time (OT) (−18 min, 95 % CI −28 to −9), less estimated blood loss (EBL) (−64 mL, 95 % CI −108 to −19) and shorter length of stay (LOS) (−1 day, 95 % CI −1.6 to 0). Proficient assistance was also independently associated with a shorter OT (−43 min, 95 % CI −53 to −33) and reduced EBL (−58 mL, 95 % CI −109 to −6), whereas those procedures performed by fixed teams were related to a shorter operation (−50 min, 95 % CI −59 to −43) and warm ischemia time (−1.8, 95 % CI −2.1 to −1.5), a reduced mean complication grade (−0.14 per patient, 95 % CI −0.3 to −0.02) and a shorter LOS (−1.1 day, 95 % CI −1.7 to −05). Health care costs for LDN by one staff surgeon with unproficient assistance were 7.707 Euro, whereas costs for LDN by two staff surgeons in fixed teams were 5.614 Euro.

Conclusions

Surgical team composition has a major impact on variables that reflect the effectiveness of LDN from the donors’ perspective. Health care costs are lower for LDNs performed by two experienced surgeons in fixed team composition. We advocate the use of two experienced surgeons in fixed team composition for LDN.

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Abbreviations

LDN:

Laparoscopic donor nephrectomy

OT:

Operation time

EBL:

Estimated blood loss

LOS:

Length of stay

WIT:

Warm ischemia time

HARP:

Hand-assisted retroperitoneoscopic donor nephrectomy

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Conflict of interest

Denise Özdemir-van Brunschot, Michiel Warlé, Michel van der Jagt, Janneke Grutters, Sharon van Horne, Heinrich Kloke, Daan van der Vliet, Johan Langenhuijsen and Frank D’Ancona have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of Vascular and Transplant Surgery, Department of Surgery, Radboud University Nijmegen Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands

    Denise M. D. Özdemir-van Brunschot, Michiel C. Warlé, Michel F. van der Jagt & Johannes A. van der Vliet

  2. Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    Johan F. Langenhuijsen & Frank C. d’Ancona

  3. Department of Nephrology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    Heinrich J. Kloke

  4. Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    Janneke P. C. Grutters & Sharon B. C. E. van Horne

Authors
  1. Denise M. D. Özdemir-van Brunschot
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  2. Michiel C. Warlé
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  3. Michel F. van der Jagt
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  4. Janneke P. C. Grutters
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  5. Sharon B. C. E. van Horne
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  6. Heinrich J. Kloke
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  7. Johannes A. van der Vliet
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  8. Johan F. Langenhuijsen
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  9. Frank C. d’Ancona
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Corresponding author

Correspondence to Denise M. D. Özdemir-van Brunschot.

Additional information

Denise M.D. Özdemir-van Brunschot and Michiel C. Warlé have contributed equally to this paper.

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Özdemir-van Brunschot, D.M.D., Warlé, M.C., van der Jagt, M.F. et al. Surgical team composition has a major impact on effectiveness and costs in laparoscopic donor nephrectomy. World J Urol 33, 733–741 (2015). https://doi.org/10.1007/s00345-014-1428-9

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  • DOI: https://doi.org/10.1007/s00345-014-1428-9

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