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Operating Room Personnel Determine Efficiency of Pediatric Spinal Fusions for Scoliosis

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Abstract

Study Design

Retrospective chart review.

Objectives

To investigate the effect of different surgeons, anesthesiologists, and cRNAs individually and in teams on various perioperative and operative time intervals in a large, high-volume children’s hospital.

Summary of Background Data

Along with individual factors, studies have indicated that team factors play a role in efficiency, with larger teams leading to increased procedure times. An operating room (OR) staff dedicated to orthopedics has been reported to decrease turnover time; however, the characteristics and behaviors of surgical team members, to our knowledge, have not been analyzed as possible factors contributing to pediatric OR efficiency, and limited research has been conducted in the field of orthopedic personnel.

Methods

Chart review identified consecutive pediatric and adolescent patients who had primary posterior spinal fusion (PSF) of ≥7 levels for correction of spinal deformity. Time intervals and delays were recorded based on previous studies looking at OR efficiency and adjusted to the specific time points available in our perioperative nursing records.

Results

Adjusted for etiology, osteotomy, fusion levels, distance from hospital, staff switch, and body mass index, there was a significant difference in patient wait time among anesthesiologists, surgeon-anesthesiologist, and anesthesiologist-certified registered nurse anesthetist (cRNA) teams; in surgery prep time and total prep among surgeons and SA teams; and in surgery time and total room time among surgeons. There were no significant differences among cRNAs, individually, in any time interval.

Conclusions

Anesthesiologists have a significant effect before and surgeons have a significant effect after entry into the OR. Identification of this variability provides an opportunity to study the differences in habits and processes of high- and low-efficiency teams, which can then be applied to all teams with the goal of improving performance of all surgical teams.

Level of Evidence

Level IV, case series.

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Author information

Authors and Affiliations

  1. College of Medicine, University of Tennessee Health Science Center, 910 Madison Ave, 38163, Memphis, TN, USA

    Jacob Hartline BS

  2. Division of Epidemiology, Biostatistics, and Environmental Health, University of Memphis, 3720 Alumni Ave, 38152, Memphis, TN, USA

    Vikki Nolan DSc, MPH

  3. Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee–Campbell Clinic, Le Bonheur Children’s Hospital, 1211 Union Ave. Suite 520, 38104, Memphis, TN, USA

    Derek M. Kelly MD, Benjamin W. Sheffer MD, David D. Spence MD, William C. Warner Jr. MD & Jeffrey R. Sawyer MD

  4. Department of Anesthesiology, Le Bonheur Children’s Hospital, 848 Adams Ave, 38103, Memphis, TN, USA

    Lilia Pereiras MD

Authors
  1. Jacob Hartline BS
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  2. Vikki Nolan DSc, MPH
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  3. Derek M. Kelly MD
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  4. Benjamin W. Sheffer MD
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  5. David D. Spence MD
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  6. Lilia Pereiras MD
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  7. William C. Warner Jr. MD
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  8. Jeffrey R. Sawyer MD
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Corresponding author

Correspondence to Jeffrey R. Sawyer MD.

Additional information

Author disclosures: JH (none), VN (none), DMK (personal fees from Elsevier and Medtronic, outside the submitted work), BWS (none), DDS (personal fees from Elsevier, from null, outside the submitted work), LP (none), WCW (personal fees from Elsevier, outside the submitted work), JRS (personal fees from DePuy, NuVasive, Elsevier, and Wolters Kluwer, outside the submitted work).

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Hartline, J., Nolan, V., Kelly, D.M. et al. Operating Room Personnel Determine Efficiency of Pediatric Spinal Fusions for Scoliosis. Spine Deform 7, 702–708 (2019). https://doi.org/10.1016/j.jspd.2019.02.003

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  • DOI: https://doi.org/10.1016/j.jspd.2019.02.003

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