Greater Familiarity Between Surgeon and Operating Room Allied Health Staff is Associated with Shorter Case Duration - A Multi-Institutional Study.

Abstract

Objective: To characterize the relationship between surgeon-staff familiarity and the time required to perform an operation.

Summary background data: The clinical and operational efficiency of operating rooms (ORs) is a driver of hospital finances and patient outcomes. Surgeon-staff familiarity is an important focus for quality improvement and process optimization.

Methods: A retrospective cohort study was performed analyzing operations performed at four academic hospitals between July 1,2019, and December 31,2023. Exclusion criteria (urgent operations, two-specialty cases, low surgeon/specialty volume in dataset, scheduled length > 8 hours) were applied to limit heterogeneity. The exposure of interest was familiarity between surgeon and allied health staff (scrub technicians and circulating nurses) present during an operation (represented as the median staff experience with the index surgeon in the previous 180 days). The primary outcome was whether the actual case length was (versus was not) 10% shorter than the scheduled case length ("shorter case length"). A secondary outcome was quantification of the difference between the observed and expected case length and whether the surgical time (cut-close) was shorter.

Results: A total of 257,645 operations performed by 25 different specialties comprised the analyzed cohort. Higher levels of surgeon-staff familiarity were associated with a higher likelihood of a shorter case length (observed:expected ratio = 1.16 [1.14-1.18] for high/high levels of familiarity, compared with 0.90 [0.88-0.91] for low/low levels of familiarity). Greater familiarity was also associated with case lengths that were shorter relative to scheduled case length (high/high levels of familiarity 8.7% shorter than low/low levels, P < 0.001). Within the four most common types of cases, those operations performed by teams with higher levels of familiarity had shorter surgical times (cut-to-close).

Conclusion: This study found that operations were more efficiently performed when the scrub technician and circulating nurse staff had a greater recent experience with the primary surgeon. Surgical team familiarity should be considered a focus of operational and clinical excellence.