The impact of team familiarity and surgical experience on operative efficiency: a retrospective analysis

Abstract

Objectives: The independent impact of individual surgical experience and team familiarity on surgical performance has been widely studied; however, the interplay of these factors and their relative, quantified, contributions to performance is poorly understood. We determined the impact of team familiarity and surgeon, and cumulative team experience on operative efficiency in total knee replacement. Design: Retrospective analysis of all total knee replacements conducted at the host institution in 1996-2009. Multivariate generalised-estimating-equation regression models were used to adjust for patient risk and clustering. Setting: Tertiary care academic hospital. Participants: All patients undergoing TKR at the host institution in 1996-2009. Main outcome measure: Operative efficiency. Results: A total of 4276 total knee replacements were completed by 1163 different surgical teams. The median experience level was 17.6 years for consultant surgeons and 3.7 years for trainee surgeons. After patient-risk adjustment, consultant surgical experience (p < 0.0001), trainee surgical experience (p < 0.05), cumulative team operative experience (p < 0.0001) and team familiarity (p < 0.0001) were associated with significant reductions in operative time. Surgical experience and team familiarity demonstrated concave and linear relationships with operative time, respectively. For a consultant surgeon, the expected reduction in operative time after 25 years in practice was 51 min, compared to a 21-min reduction over the span of 40 collaborations with the same team members. Conclusions: Surgical experience and team familiarity display important and distinct relationships with operative time in total knee replacement. Appreciation of this interplay may serve to guide implementation and allocation of procedurespecific quality improvement strategies in surgery.

Anticipation, teamwork and cognitive load: chasing efficiency during robot-assisted surgery

“…Inconvenience events lead to prolongation of surgery times, which is associated with higher costs and less favourable clinical outcomes 5 25 29 30. This goes in hand with prior studies that demonstrated the benefit of both surgical experience and team familiarity 17. This establishes the potential importance of considering these factors when the aim is to improve surgical efficiency and patient safety, and also opens new opportunities and creates new challenges for quality improvement strategies for RAS.…”

Interruptions in Surgery: A Comprehensive Review

“…62 It has been demonstrated that a high level of familiarity decreases the number of interruptions, 28,36,49 improves the performance of the surgical team by decreasing the duration of the surgical procedure 63 and postoperative complications, 64 and by promoting teamwork and communication. 65 •Technology. Interruptions related to equipment problems represented the highest risk of significant impact on the surgical procedure.…”

Surgical team: improving teamwork, a review

“…Maruthappu et al 26 focused on perioperative outcomes in total knee replacements and correlation with surgical experience and team familiarity. Although surgical experience has been previously shown to positively impact on performance,27–29 this study furthered this concept by investigating collective experience of the team members to build on ElBardissi et al ’s study 30.…”