Abstract
Background
Previous studies on surgical team composition have shown that surgical team size had an independent impact on surgical performance in US and Canadian hospitals. We aimed to investigate the impact of team composition on surgical performance in two Chinese hospitals.
Methods
General surgery procedures performed from April 2011 to June 2012 were retrospectively reviewed to record the number of attendees in the operating room (OR) and the procedure time (PT).
Results
A total of 1,900 valid procedures, mostly laparoscopic, were performed during the study period. The mean PT was 90.5 min. On average, there were a total of 6 (range = 3–8) team members per procedure: 3 (range = 1–5) surgeons, 2 nurses, and 1 anesthesiologist. Unlike the data reported for the US and Canada, the number of nurses and anesthesiologists remained stable in most cases, whereas the number of surgeons differed by procedure. Multiple-regression analysis revealed that both the complexity of the operation and the team size significantly affected PT. When procedure complexity and patient condition were kept constant, adding one team member in our data analysis predicted an increase of 34.7 min in the PT.
Conclusion
The surgical team size has a measurable effect on PT. Aside from surgical complexity, the team composition and member stability affected PT in the OR. Optimizing surgical teams and developing a strategy to maintain team stability are of great importance for improving OR efficiency.
Similar content being viewed by others
References
Aggarwal R, Undre S, Moorthy K, Vincent C, Darzi A (2004) The simulated operating theatre: comprehensive training for surgical teams. Qual Saf Health Care 13:i27–i32
Baker DP, Gustafson S, Beaubien J, Salas E, Barach P (2005) In: Agency for Healthcare Research and Quality (ed), Medical Teamwork and Patient Safety: The Evidence-based Relation. Literature Review. Rockville, MD: Agency for Healthcare Research and Quality, AHRQ Publication No. 05-0053. Available at http://www.ahrq.gov/qual/medteam/. Accessed 1 Mar 2013
Moorthy K, Munz Y, Adams S, Pandey V, Darzi A (2005) A human factors analysis of technical and team skills among surgical trainees during procedural simulations in a simulated operating theatre. Ann Surg 242:631–639
Kenyon TA, Lenker MP, Bax TW, Swanstrom LL (1997) Cost and benefit of the trained laparoscopic team. A comparative study of a designated nursing team vs a nontrained team. Surg Endosc 11:812–814
de Leval MR, Carthey J, Wright DJ, Farewell VT, Reason JT (2000) Human factors and cardiac surgery: a multicenter study. J Thorac Cardiovasc Surg 119:661–672
Cassera MA, Zheng B, Martinec DV, Dunst CM, Swanstrom LL (2009) Surgical time independently affected by surgical team size. Am J Surg 198:216–222
Zheng B, Panton ON, Al-Tayeb TA (2012) Operative length independently affected by surgical team size: data from 2 Canadian hospitals. Can J Surg 55:371–376
Zheng B, Panton ON, Al-Tayeb TA, Meneghetti AT, Qayumi AK (2012) Impact of surgical team size on intraoperative performance: data from 2 Canada hospitals. Can J Surg. doi:10.1503/cjs.011311
American Medical Association (2013) Current Procedural Terminology. Available at https://commerce.ama-assn.org/store/content/rvusearch?node_id=nn409. Accessed 1 Mar 2013
Thomas EJ, Sexton JB, Helmreich RL (2003) Discrepant attitudes about teamwork among critical care nurses and physicians. Crit Care Med 31:956–959
Xiao Y, Kim YJ, Gardner SD, Faraj S, MacKenzie CF (2006) Communication technology in trauma centers: a national survey. J Emerg Med 30:21–28
Gawande AA, Zinner MJ, Studdert DM, Brennan TA (2003) Analysis of errors reported by surgeons at three teaching hospitals. Surgery 133:614–621
Parker SH, Flin R, McKinley A, Yule S (2012) The Surgeons’ Leadership Inventory (SLI): a taxonomy and rating system for surgeons’ intraoperative leadership skills. Am J Surg. doi:10.1016/j.amjsurg.2012.02.020
Carthey J, de Leval MR, Reason JT (2001) The human factor in cardiac surgery: errors and near misses in a high technology medical domain. Ann Thorac Surg 72:300–305
Low D, Walker I, Heitmiller ES (2012) Implementing checklists in the operating room. Pediatr Anesth 22:1025–1031
Stepaniak PS, Vrijland WW, de Quelerij M, de Vries G, Heij C (2010) Working with a fixed operating room team on consecutive similar cases and the effect on case duration and turnover time. Arch Surg 145:1165–1170
Zheng B, Swanstrom LL, Meneghetti A, Panton ON, Qayumi AK (2011) Quantifying surgeon’s contribution to team effectiveness on a mixed team with a junior surgeon. Surgery 149:761–765
Acknowledgments
The authors gratefully acknowledge Maria Cassera for polishing this article.
Disclosures
Wenjing He, Shenghao Ni, Gengzhen Chen, Xuewu Jiang, and Bin Zheng have no conflicts of interest or financial ties to disclose. Bin Zheng is employee at University of Alberta, but this had no financial impact on the publication of this article. This study was not supported by any pharmaceutical company or grants; the cost was borne by the authors’ institutions. This article is not based on a previous communication to a society or meeting.
Author information
Authors and Affiliations
Corresponding author
Additional information
Wenjing He and Shenghao Ni contributed equally to this work.
Rights and permissions
About this article
Cite this article
He, W., Ni, S., Chen, G. et al. The composition of surgical teams in the operating room and its impact on surgical team performance in China. Surg Endosc 28, 1473–1478 (2014). https://doi.org/10.1007/s00464-013-3318-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-013-3318-4