Operating list composition and surgical performance

Pike, Thomas W.; Mushtaq, Faisal; Mann, Richard P.; Chambers, P; Hall, Geoff; Tomlinson, James; Mir, Rohana; Wilkie, Richard M.; Mon-Williams, Mark; Lodge, J.P.A.

doi:10.1002/bjs.10804

Cited by 12 publications

(10 citation statements)

References 47 publications

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“…[34][35][36][37][38][39][40] Interventions that directly target cognitive and motor preparation are showing promise. The benefits of 'warming up' for optimal surgical performance are becoming clearer, [41][42][43] with emerging evidence indicating that the risk of intraoperative errors related in perceptual identification and spatial orientation might be ameliorated by preoperative interaction with virtual and physical visual aids. 44,45 Such interventions are unlikely to work in isolation, however; healthcare delivery is a complex process involving the interactions of dynamical systems and, as such, interventions at the proximal level need to be considered in the context of the system in which they are embedded.…”

Section: Discussionmentioning

confidence: 99%

Contributory factors in surgical incidents as delineated by a confidential reporting system

Mushtaq

O’Driscoll

Smith

et al. 2018

annals

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Background Confidential reporting systems play a key role in capturing information about adverse surgical events. However, the value of these systems is limited if the reports that are generated are not subjected to systematic analysis. The aim of this study was to provide the first systematic analysis of data from a novel surgical confidential reporting system to delineate contributory factors in surgical incidents and document lessons that can be learned. Methods One-hundred and forty-five patient safety incidents submitted to the UK Confidential Reporting System for Surgery over a 10-year period were analysed using an adapted version of the empirically-grounded Yorkshire Contributory Factors Framework. Results The most common factors identified as contributing to reported surgical incidents were cognitive limitations (30.09%), communication failures (16.11%) and a lack of adherence to established policies and procedures (8.81%). The analysis also revealed that adverse events were only rarely related to an isolated, single factor (20.71%) - with the majority of cases involving multiple contributory factors (79.29% of all cases had more than one contributory factor). Examination of active failures - those closest in time and space to the adverse event - pointed to frequent coupling with latent, systems-related contributory factors. Conclusions Specific patterns of errors often underlie surgical adverse events and may therefore be amenable to targeted intervention, including particular forms of training. The findings in this paper confirm the view that surgical errors tend to be multi-factorial in nature, which also necessitates a multi-disciplinary and system-wide approach to bringing about improvements.

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Section: Discussionmentioning

confidence: 99%

Contributory factors in surgical incidents as delineated by a confidential reporting system

Mushtaq

O’Driscoll

Smith

et al. 2018

annals

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“…Several recent studies and reviews report that the order of the theatre list influences surgical performance. [5][6][7] This includes a significant effect on the operating time, especially on lists where the same procedure is repeated. 5 It has also been suggested that the complexity of the case could be a crucial criterion for list ordering.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] This includes a significant effect on the operating time, especially on lists where the same procedure is repeated. 5 It has also been suggested that the complexity of the case could be a crucial criterion for list ordering. We, therefore, investigated how case complexity influences the order of the list in this survey-based study completed by varying grades of cataract surgeons.…”

Section: Discussionmentioning

confidence: 99%

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Establishing the influence of case complexity on the order of cataract lists: a cross-sectional survey

et al. 2021

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ObjectiveOrder of the theatre list and complexity of the cases are important considerations which are known to influence surgical outcomes. This survey aimed to establish their influence on cataract surgery.Methods and AnalysisCataract surgeons ordered five cataract cases according to their surgical preference, first using case notes and second using composite ORs (CORs) for posterior capsule rupture. Descriptive and non-parametric statistics were used to analyse the data.ResultsBetween 11 June and 14 July 2020, 192 cataract surgeons from 14 countries completed the online survey. Majority of the surgeons (142 vs 50) preferred to choose the order of their list (p<0.01) and to review the case notes prior to the day of surgery (89 vs 53; p=0.04). 39.86% preferred to start with the less risky case and 32.43% reserved the last position on the list for the riskiest case. There was a significant trend to order the list in an ascending level of risk, independent of whether case notes or CORs were used. Additionally, 44.79% of the respondents indicated they would be happy to have their list order planned by an automated program based on their preferred risk score.ConclusionThis survey demonstrates that cataract surgeons prefer to choose the order of their theatre list and that the order is dependent on the complexity of cases. There is support among surgeons for automated list ordering based on an objective score for risk stratification, such as a COR.

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“…In addition, a predictable operative duration is crucial for the efficient scheduling of operating room utilization, as both under-and overscheduling have major economic impacts. Among other factors, the team composition plays a relevant role in the operative duration beyond the learning curve [14][15][16][17][18]. To date, the impact of the surgical team composition on the duration of enbloc robot-assisted radical cystectomy and nephro-ureterectomy, a complex, multistep procedure, has not been explored.…”

Section: Introductionmentioning

confidence: 99%

Surgical benchmarks, mid-term oncological outcomes, and impact of surgical team composition on simultaneous enbloc robot-assisted radical cystectomy and nephroureterectomy

Buse

Alexandrov²,

Mazzone

et al. 2021

BMC Urol

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Background Simultaneous urothelial cancer manifestation in the lower and upper urinary tract affects approximately 2% of patients. Data on the surgical benchmarks and mid-term oncological outcomes of enbloc robot-assisted radical cystectomy and nephro-ureterectomy are scarce. Methods After written informed consent was obtained, we prospectively enrolled consecutive patients undergoing enbloc radical cystectomy and nephro-ureterectomy with robotic assistance from the DaVinci Si-HD® system in a prospective institutional database and collected surgical benchmarks and oncological outcomes. Furthermore, as one console surgeon conducted all the procedures, whereas the team providing bedside assistance was composed ad hoc, we assessed the impact of this approach on the operative duration. Results Nineteen patients (9 women), with a mean age of 73 (SD: 7.5) years, underwent simultaneous enbloc robot-assisted radical cystectomy and nephro-ureterectomy. There were no cases of conversion to open surgery. In the postoperative period, we registered 2 Clavien-Dindo class 2 complications (transfusions) and 1 Clavien-Dindo class 3b complication (port hernia). After a median follow-up of 23 months, there were 3 cases of mortality and 1 case of metachronous urothelial cancer (contralateral kidney).The total operative duration did not decrease with increasing experience (r = 0.174, p = 0.534). In contrast, there was a significant, inverse, strong correlation between the console time relative to the total operative duration and the number of conducted procedures after adjusting for the degree of adhesions and the type of urinary diversion(r = -0.593, p = 0.02). Conclusions These data suggest that en bloc simultaneous robot-assisted radical cystectomy and nephro-ureterectomy can be safely conducted with satisfactory mid-term oncological outcomes. With increasing experience, improved performance was detectable for the console surgeon but not in terms of the total operative duration. Simulation training of all team members for highly complex procedures might be a suitable approach for improving team performance. Trial registration: Not applicable.

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Operating list composition and surgical performance

Cited by 12 publications

References 47 publications

Contributory factors in surgical incidents as delineated by a confidential reporting system

Contributory factors in surgical incidents as delineated by a confidential reporting system

Establishing the influence of case complexity on the order of cataract lists: a cross-sectional survey

Surgical benchmarks, mid-term oncological outcomes, and impact of surgical team composition on simultaneous enbloc robot-assisted radical cystectomy and nephroureterectomy

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