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. 2018 Jul;105(8):1061-1069.
doi: 10.1002/bjs.10804. Epub 2018 Mar 20.

Operating list composition and surgical performance

T W Pike  1   2 , F Mushtaq  1 , R P Mann  3 , P Chambers  4 , G Hall  4   2 , J E Tomlinson  5   6 , R Mir  1   2 , R M Wilkie  1 , M Mon-Williams  1 , J P A Lodge  1   2   7
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Operating list composition and surgical performance

T W Pike et al. Br J Surg. 2018 Jul.

Abstract

Background: Recent reviews suggest that the way in which surgeons prepare for a procedure (warm up) can affect performance. Operating lists present a natural experiment to explore this phenomenon. The aim was to use a routinely collected large data set on surgical procedures to understand the relationship between case list order and operative performance.

Method: Theatre lists involving the 35 procedures performed most frequently by senior surgeons across 38 private hospitals in the UK over 26 months were examined. A linear mixed-effects model and matched analysis were used to estimate the impact of list order and the cost of switching between procedures on a list while controlling for key prognosticators. The influence of procedure method (open versus minimally invasive) and complexity was also explored.

Results: The linear mixed-effects model included 255 757 procedures, and the matched analysis 48 632 pairs of procedures. Repeating the same procedure in a list resulted in an overall time saving of 0·98 per cent for each increase in list position. Switching between procedures increased the duration by an average of 6·48 per cent. The overall reduction in operating time from completing the second procedure straight after the first was 6·18 per cent. This pattern of results was consistent across procedure method and complexity.

Conclusion: There is a robust relationship between operating list composition and surgical performance (indexed by duration of operation). An evidence-based approach to structuring a theatre list could reduce the total operating time.

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Figures

Figure 1
Figure 1
Flow chart illustrating how sample sizes were determined for the linear‐mixed effects and matched analyses from the original data set
Figure 2
Figure 2
Forest plots showing percentage change in duration of operation for the top 35 procedures in the database based on the influence of fixed model parameters: a absolute list order, b procedure‐specific list order and c procedure switch. Negative values indicate the percentage reduction in duration of operation given an increase in each parameter, and positive values the percentage increase. The top row in each panel shows the overall effect of each fixed parameter. Error bars represent 95 per cent confidence intervals. Procedures are identified by AXA Specialist Procedure Codes (Table S1, supporting information)
Figure 3
Figure 3
Duration of operation as a function of procedure‐specific list order for three routine procedures: a primary open inguinal hernia repair (with mesh); b oesophagogastroduodenoscopy (with biopsy of lesion) and c lens implant for cataract. Error bars represent 95 per cent confidence intervals
Figure 4
Figure 4
Forest plot from matched analysis illustrating the percentage change in duration of operation for procedure‐specific list order 2 procedures compared with list order 1. Error bars represent 95 per cent confidence intervals. Procedures are identified by AXA Specialist Procedure Codes (Table S1, supporting information)
Figure 5
Figure 5
Percentage change in duration of operation time according to a surgical method and b complexity for matched wake analysis. Error bars represent 95 per cent confidence intervals
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References

    1. Collins FS, Varmus H. A new initiative on precision medicine. N Engl J Med 2010; 363: 1–3. - PMC - PubMed
    1. Department of Health . Operational Productivity and Performance in English NHS Acute Hospitals: Unwarranted Variations. Department of Health: London, 2016.
    1. Mann RP, Mushtaq F, White AD, Mata‐Cervantes G, Pike T, Coker D et al The problem with big data: operating on smaller datasets to bridge the implementation gap. Front Public Health 2016; 4: 2–5. - PMC - PubMed
    1. Mazzei WJ. Operating room start times and turnover times in a university hospital. J Clin Anesth 1994; 6: 405–408. - PubMed
    1. Farrow SC, Fowkes FGR, Lunn JN, Robertson IB, Samuel P. Epidemiology in anaesthesia II: factors affecting mortality in hospital. Br J Anaesth 1982; 54: 811–817. - PubMed

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