Abstract
Introduction
With the growing emphasis on the cost of medical care, there is renewed interest in the productivity and efficiency of surgical procedures. We have developed a method to systematically examine the efficiency of the surgical team during primary total knee replacement (TKR). In this report, we present data derived from a series of procedures performed by different joint surgeons. This data demonstrates a variation between the duration and efficiency of each step in this procedure and its relationship to the experience and coordination of the surgeon working with the scrub team.
Methods
After consent was achieved, videotaped recordings were prepared of ten primary TKR procedures performed by five highly experienced joint surgeons. For quantitative analysis, each procedure was divided into 7 principal tasks from initial incision to wound closure. In order to quantify efficiency, we recorded the occurrence of events leading to delays in each step of the procedure. Starting with a total score of 100 points, deductions were made, based on the number of delaying events and its impact on the efficiency of the procedure. A final score for the surgery was then determined using the individual scores from each principal task. The experience of each member of the surgical team in participating in TKR, and in working with the surgeon, were recorded and correlated with the total efficiency score for the entire procedure.
Results
The average duration of the 10 procedures examined was 55 minutes (range: 38 to 81 mins). The longest steps during the procedure were closing the incision (13 mins; 24%) and performing the osteotomies of the distal femur (12 mins; 22%). A total of 570 delaying events were recorded from 10 surgeries, an average of 57 per surgery; least frequently the surgeon was handed the wrong instrument (0.4 /case), and most commonly, the surgeon diverting his attention from the surgical field, (35.2 times/ case). Using our scoring system, the mean efficiency of the surgeries was 81.2%. The least efficient step was performing osteotomies of the distal femur (71.5%), whereas the opening incision is the most efficient step (96%). The median experience of the surgical assistant working with each operating surgeon was 5 years. Surgical team experience correlated positively with efficiency. The mean score of surgeries of teams with 5 years experience was 81.2%, vs. only 71.9% when the surgical tech had never operated with the surgeon previously.
Conclusions
The results of this study confirm that team experience has an important impact on the efficiency of operative procedures, and hence the duration of the operations that they perform. This suggests that training exercises that promote teamwork and the operative knowledge of each team member will have a beneficial effect on the efficiency of surgical facilities.
