Bariatric Surgery with Operating Room Teams that Stayed Fixed During the Day

BackgroundTeamwork in the operating theatre is becoming increasingly recognized as a major factor in clinical outcomes. Many tools have been developed to measure teamwork. Most fall into two categories: self‐assessment by theatre staff and assessment by observers. A critical and comparative analysis of the validity and reliability of these tools is lacking.MethodsMEDLINE and Embase databases were searched following PRISMA guidelines. Content validity was assessed using measurements of inter‐rater agreement, predictive validity and multisite reliability, and interobserver reliability using statistical measures of inter‐rater agreement and reliability. Quantitative meta‐analysis was deemed unsuitable.ResultsForty‐eight articles were selected for final inclusion; self‐assessment tools were used in 18 and observational tools in 28, and there were two qualitative studies. Self‐assessment of teamwork by profession varied with the profession of the assessor. The most robust self‐assessment tool was the Safety Attitudes Questionnaire (SAQ), although this failed to demonstrate multisite reliability. The most robust observational tool was the Non‐Technical Skills (NOTECHS) system, which demonstrated both test–retest reliability (P > 0·09) and interobserver reliability (Rwg = 0·96).ConclusionSelf‐assessment of teamwork by the theatre team was influenced by professional differences. Observational tools, when used by trained observers, circumvented this.

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“…SAQ scores correlated with theatre efficiency, but not with an independent scoring system for communication3 17.…”

Section: Resultsmentioning

confidence: 74%

“…The most popular tool was the teamwork subsection or ‘climate’ of the SAQ2 3, 15, 16, 17, 18, 19, 20.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of methods for quantifying teamwork in the operating theatre

Marshall

Sykes

et al. 2018

BJS Open

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“…This may be applicable in the current study as well, however, primary RYGBP has been performed for many years by experienced surgeons at this centre and the surgical technique of a revisional RYGBP is essentially similar to the one of a primary RYGBP. The use of fixed operating room teams during the day will have a contributing factor as well [25]. These fixed teams were implemented at the same time as the use of the fast track protocol in this hospital.…”

Section: Discussionmentioning

confidence: 99%

Conventional versus fast track anaesthesia in an unselected group of patients undergoing revisional bariatric surgery

Wezenbeek

Pouwels

Buise

et al. 2015

International Journal of Surgery Open

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Introduction:Fast track care has proven to be safe and effective in primary bariatric procedures. The number of more complex revisional procedures is expected to rise over the next years. The aim was to evaluate the potential benefits and safety of a fast-track protocol in an unselected group of patients undergoing Roux-en-Y Gastric Bypass (rRYGBP) as revision. Method: For this retrospective study, all patients undergoing rRYGBP between January 2005 and December 2013 were included and categorized between conventional care (CC) and fast track care (FT). Patient characteristics, operative details and intra-and early postoperative complications < 30 days were analysed. Results: A total of 407 patients were included for analysis. 303 patients (74.4%) received peri-and postoperative treatment according to the fast track protocol. Mean age of the study population was 44.0 ± 8.9 years; mean pre-primary procedure BMI was 45.7 ± 7.0 kg/m 2 . A total of 54 (13.3%) postoperative complications were registered (CC 19.2% vs FT 11.2%; p = 0.038). Both operative time (CC 135.3 ± 42.6 minutes vs FT 79.3 ± 29.3 minutes; p < 0.001) as well as hospital stay (CC 5.1 ± 6.3 days vs FT 3.1 ± 5.3 days; p < 0.001) were significantly shorter in the FT group. A multivariate analysis on postoperative complications showed that fast track was not predictive for the occurrence of complications (OR = 0.853; 95% CI [0.403-1.804]; p = 0.677). Conclusion:Fast track care appears to be safe and efficient for patients undergoing revisional Rouxen-Y gastric bypass, but postoperative outcome may be highly dependent on surgical experience.

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“…The important role of organizing the OR functioning and its influence on bariatric patients’ outcomes has been emphasized by Stepaniak et al . [23]. …”

Section: Discussionmentioning

confidence: 99%

Redesigning the process of laparoscopic sleeve gastrectomy based on risk analysis resulted in 100 consecutive procedures without complications

Kaska¹,

Proczko²,

Stefaniak³

et al. 2013

wiitm

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IntroductionIn recent years, laparoscopic sleeve gastrectomy (LSG) is becoming increasingly popular. The quite simple technique, lack of anastomoses, fully stapling course of the resection and the laparoscopic approach influence the attractiveness of the procedure from the surgeon's perspective. Though the feasibility of LSG is appreciated, the range of complications seems to be considerable.AimTo prospectively evaluate modification of the bariatric process in LSG patients.Material and methodsThe initial results of the first series of LSG patients (G1) were unacceptable and led to redefinition, based on risk analysis, of the entire bariatric process. A number of corrective and preventive actions were implemented into the process. The impact of innovations on the outcomes of the next 100 LSGs (G2) was assessed. Complications, intraoperative difficulties and postoperative adverse events were registered.ResultsThe total complication rate of the G1 group was 32% (8/25 patients). When several corrective and preventive actions were implemented in the subsequent process, there were no postoperative complications observed in the G2 group. Sixteen intraoperative difficulties were encountered in group G2 but resolved intraoperatively and did not affect the postoperative course.ConclusionsThe systemic approach to the LSG procedure by innovating the entire process significantly reduced the rate of complications. The ‘learning curve’ should not be limited only to the manual operative training. Preventive actions based on risk analysis should be considered as the core component in redesigning the process.

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Bariatric Surgery with Operating Room Teams that Stayed Fixed During the Day

Abstract: Working with fixed teams in bariatric surgery reduced procedure durations and improved teamwork and safety climate, without adverse effects on patient outcomes.

Cited by 54 publications

References 27 publications

Systematic review of methods for quantifying teamwork in the operating theatre

Systematic review of methods for quantifying teamwork in the operating theatre

Conventional versus fast track anaesthesia in an unselected group of patients undergoing revisional bariatric surgery

Redesigning the process of laparoscopic sleeve gastrectomy based on risk analysis resulted in 100 consecutive procedures without complications

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