Effect of team dynamics on operative efficiency in total joints

Editor's Note

In this study led by California's Stanford Health Care, researchers found significant associations of surgical team composition and dynamics with operative efficiency for total hip (THAs) and total knee arthroplasties (TKAs), independent of case complexity.

The analysis included 641 total joint arthroplasties (279 THAs and 362 TKAs) performed over a year.

Among the findings:

• Turnover of circulating nurses was linked to a significant increase in operative duration, with estimated differences of 19.6 minutes of room time in THAs and 14.0 minutes in TKAs.
• The presence of a preferred anesthesiologist or surgical technician was associated with significant decreases of 26.5 minutes of procedure time and 12.6 minutes of room time, respectively, in TKAs.
• The presence of a surgeon-preferred vendor was tied to a significant increase in operative duration in both THAs (26.3 minutes) and TKAs (29.6 minutes).

The findings show that operative efficiency is associated with the dynamics of the surgical team. As hospitals refine OR guidelines and adopt technologies to reduce errors, management of surgical team dynamics and communication during turnover may be a powerful tool for improving operative efficiency and patient safety, the researchers conclude.