Associate Professor of Urology and OB/Gyn Mayo Clinic, Rochester, MN
Introduction: We evaluated the impact of consistent operating room teams on operating efficiency and patient outcomes. Methods: Patients undergoing major urologic surgery (prostatectomy, nephrectomy, or cystectomy) at a single institution from 2010-2019 were identified. The surgical team was defined as a certified surgical assistant, certified surgical technologist and circulating nurse. Primary team member status was assigned on a quarterly basis for individuals involved with the highest proportion of a surgeon’s cases. Operative efficiency outcomes included time to first incision of the day, case length, and turn-over (time from closure to the next incision). Perioperative clinical outcomes included length of hospitalization, 30-day readmission and reoperation. Outcomes were assessed via univariate and multivariable analyses. Results: A total of 11213 urologic surgeries were included for analyses. Increasing number of primary team members (2-3 vs 0-1) was associated with decreased time to first incision (median 48min (IQR 39,62) vs 52min (IQR 43, 66);p < 0.0001) and turn-over time (median 93min [IQR 80, 111] vs 100min [85, 122];p < 0.0001). On multivariable analyses, increased team consistency remained significantly associated with decreased turn-over time (-7.23min [95%CI -9.8 to -4.66]; p<0.0001) and time to first incision (-2.04min [95%CI -2.68 to -1.41;p < 0.0001). Moreover, among minimally invasive nephrectomies, a more consistent team was associated with a significantly decreased odds of prolonged hospitalization (>90%tile) (OR 0.63, 95%CI 0.47-0.84;p=0.001), while among robotic prostatectomies, increased team consistency was associated with decreased case length (-4.55min, 95%CI -7.48 to -1.62;p=0.002). Conclusions: The presence of consistent operative teams was associated with improved operating room efficiency and length of hospitalization. SOURCE OF Funding: None
