Effect of surgeon fatigue on hip and knee arthroplasty

Peskun, Christopher; Walmsley, David; Waddell, James P.; Schemitsch, Emil H.

doi:10.1503/cjs.032910

Cited by 28 publications

(19 citation statements)

References 39 publications

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“…It has been demonstrated that performing preoperative warm-up exercises for approximately 15 minutes with simple surgical tasks lead to a substantial increase in surgical skill pro ciency [12]. A few studies found that surgeon fatigue increased throughout the operative day, causing an increase in the time required to complete surgeries [9,[13][14]. A study by Willis-Owen et al suggested that a longer duration of surgery for TKA led to an increased infection rate [15].…”

Section: Discussionmentioning

confidence: 99%

“…Based on a predigestion technique and improvements in implants, ve or more arthroplasty cases are planned in a single operating room each day in many large orthopaedics centres. To date, few studies have examined the in uence of surgical case order on the surgical complication rate or clinical outcome of total knee joint arthroplasty, and the results have been con icting [7][8][9]. In the current study, we retrospectively viewed our centre's experience to examine whether the case order in uenced the perioperative outcomes of TKA.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Case Order is an Independent Risk Factor for Postoperative Infection in Primary Total Knee Arthroplasty

Jia

Lü

et al. 2021

Preprint

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Background: Total knee arthroplasty is regarded as the most effective treatment for severe knee joint problems. Surgery case order influences operative outcomes according to previous studies. This study aims to evaluate the effect of surgical case order on operative outcomes for TKA.Methods: A retrospective study was conducted on 4,267 TKAs performed by three surgeons at our hospital from February 2008 to February 2018. Variables, such as surgical time, loss of blood, and hospitalization stay, were also recorded and analysed. Logistic regression was used to analyse every variable as a potential risk for a surgical site infection.Results: Of the 4267 cases in this cohort, 1531 TKAs were classified as first-round cases, 1194 TKAs were second-round cases, 913 TKAs were third-round cases, 490 TKAs were fourth-round cases, and 139 were fifth-round or later cases. The mean operating time was shorter in intermediate cases (P< 0.01). Perioperative adverse events were increased in later surgical cases (P< 0.01). Later case order (OR= 1.29 [95% CI: 1.17–1.56], P<0.01) was a significant risk factor for severe arthroplasty complications. The operative time and length of stay were increased for cases performed later in the day. However, blood loss is not statistically associated with case order. Conclusions: Surgical case order is an independent risk factor for surgical infection. Significantly increased operative time and longer LOS were noted for third-round or later TKA cases. Our results identify potentially modifiable risk factors contributing to infection rates in TKA, and cases operated on later in the day in the same room were more likely to have a higher infection risk.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical Case Order is an Independent Risk Factor for Postoperative Infection in Primary Total Knee Arthroplasty

Jia

Lü

et al. 2021

Preprint

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“…There is support in the literature that patient outcomes are adversely affected by time-of-day and fatigue in operator-dependent cognitive and technical tasks (11). Specifically laparoscopic procedures, cardiac interventions, and endotracheal intubations have been shown to have inferior outcomes when performed later in the day (6,12,13).…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive surgery for endometrial cancer: Does operative start time impact surgical and oncologic outcomes?

Slaughter

Frumovitz

Schmeler

et al. 2014

Gynecologic Oncology

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Objective Recent literature in ovarian cancer suggests differences in surgical outcomes depending on operative start time. We sought to examine the effects of operative start time on surgical outcomes for patients undergoing minimally invasive surgery for endometrial cancer. Methods A retrospective review was conducted of patients undergoing minimally invasive surgery for endometrial cancer at a single institution between 2000 and 2011. Surgical and oncologic outcomes were compared between patients with an operative start time before noon and those with a surgical start time after noon. Results A total of 380 patients were included in the study (245 with start times before noon and 135 with start times after noon). There was no difference in age (p=0.57), number of prior surgeries (p=0.28), medical comorbidities (p=0.19), or surgical complexity of the case (p=0.43). Patients with surgery starting before noon had lower median BMI than those beginning after noon, 31.2 vs. 35.3 respectively (p=0.01). No significant differences were observed for intraoperative complications (4.4% of patients after noon vs. 3.7% of patients before noon, p=0.79), estimated blood loss (median 100 cc vs. 100 cc, p=0.75), blood transfusion rates (7.4% vs. 8.2%, p=0.85), conversion to laparotomy (12.6% vs. 7.4%, p=0.10). There was no difference in operative times between the two groups (198 minutes vs. 216.5 minutes, p=0.10). There was no association between operative start time and postoperative non-infectious complications (11.9% vs. 11.0%, p=0.87), or postoperative infections (17.8% vs. 12.3%, p=0.78). Length of hospital stay was longer for surgeries starting after noon (median 2 days vs. 1 day, p=0.005). No differences were observed in rates of cancer recurrence (12.6% vs. 8.8%, p=0.39), recurrence-free survival (p=0.97), or overall survival (p=0.94). Conclusion Our results indicate equivalent surgical outcomes and no increased risk of postoperative complications regardless of operative start time in minimally invasive endometrial cancer staging, despite longer length of hospital stay for surgeries beginning after noon.

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“…Usually, it is believed that operative duration depends on factors related to clinical issues or patients [1], e.g., age, gender, and body mass index. It is also found that operative duration is affected by the surgeon's operating skills [2,3], assistant surgeons [4,5] management policies [6], switching of teams [7], and surgeon fatigue [8]. Predictors of operative duration of general thoracic surgeries are identified in [9].…”

Section: Introductionmentioning

confidence: 99%

Clinical and Nonclinical Effects on Operative Duration: Evidence from a Database on Thoracic Surgery

Wang

Cabrera

Tsui

et al. 2020

Journal of Healthcare Engineering

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Background. Due to the high maintenance costs, it is critical to make full use of operating rooms (ORs). Operative duration is an important factor that guides research on surgery scheduling. Clinical effects, for example, surgery type, rationally influences operative duration. In this study, we also investigate whether the planning and scheduling decisions in ORs influence the operative duration. Methods. For our study, we collected and reviewed data on 2,451 thoracic operations from a large hospital in China. The study was conducted over a period of 34 months. Linear and nonlinear regression models were used to detect the effects on the duration of the operations. We have also examined interactions between the factors. Results. Operative duration decreased with the number of operations a surgeon performed in a day (P<0.001). It was also found that operative duration decreased with the number of operations allocated to an OR, as long as there were not more than four surgeries per day (P<0.001). However, they increased with the number of operations if it was more than four (P<0.01). The duration of surgery was affected by its position in the sequencing of surgeries performed by a surgeon. In addition, the effects of surgeons depend on the surgery type as well as the position in the sequencing order. Conclusions. Operative duration was affected not only due to clinical effects but also some nonclinical effects. Scheduling decisions significantly influenced operative duration.

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Effect of surgeon fatigue on hip and knee arthroplasty

Abstract: Duration of surgery and incidence of intraoperative complications for THA may increase with later surgery start time; however, the relatively small statistical differences observed imply that they likely are not clinically significant.

Cited by 28 publications

References 39 publications

Surgical Case Order is an Independent Risk Factor for Postoperative Infection in Primary Total Knee Arthroplasty

Surgical Case Order is an Independent Risk Factor for Postoperative Infection in Primary Total Knee Arthroplasty

Minimally invasive surgery for endometrial cancer: Does operative start time impact surgical and oncologic outcomes?

Clinical and Nonclinical Effects on Operative Duration: Evidence from a Database on Thoracic Surgery

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