Intraoperative Scrub Nurse Handoffs Are Associated With Increased Operative Times for Total Joint Arthroplasty Patients

Abstract

Background: Surgeons typically remain scrubbed in for the duration of a surgical case, while scrub nurses are shift-workers who handoff mid-operation. These handoffs can intuitively create inefficiencies, but currently, no orthopedic research has studied the impact of these handoffs. This study analyzed the effect of intraoperative scrub nurse handoffs on operative times for total joint arthroplasties (TJAs).

Methods: A retrospective chart review was performed for primary total hip (THA) and total knee arthroplasties (TKA) performed between May 2014 and May 2018. Operative times, number of scrub nurse handoffs, surgeon, and patient information were collected. A multivariable linear regression was performed to assess the association between patient and surgeon characteristics, intraoperative handoffs, and operative times.

Results: A total of 1109 TKA and 1032 THA patients were identified. Multivariable linear regression demonstrated that for TKAs, 1 handoff was associated with a 3.89-minute longer operative time (P value = .02), and 2+ handoffs were associated with a 15.99-minute longer case (P value < .001). For THA patients, 1 handoff was associated with a 6.20-minute longer operative time (P value < .001), and 2+ handoffs were associated with an 18.52-minute longer case (P value < .001).

Conclusions: Although causation cannot be established, when controlling for multiple confounders, intraoperative scrub nurse handoffs were associated with statistically significant increases in operative times for TJAs. Optimizing scrub nurse staffing models to decrease intraoperative handoffs could thus have practical ramifications on TJA patients.

Keywords: Hospital efficiency; Hospital staffing; Intra-operative handoffs; Total hip arthroplasty; Total knee arthroplasty.

Figure 1

Operative times (minutes) for TKA patient demographic groups, stratified by number of intraoperative scrub nurse handoffs (0, 1, 2+). Error bars represent 95% confidence intervals. P values for one-way ANOVA for each group is listed on the right side of grouped columns.

Figure 2

Operative times (minutes) for THA patient demographic groups, stratified by number of intraoperative scrub nurse handoffs (0, 1, 2+). Error bars represent 95% confidence intervals. P values.