Operative length independently affected by surgical team size: data from 2 Canadian hospitals

Knowledge of the composition of a surgical team is the premise for studying efficiency inside the operating room.

To investigate the team composition in general surgery procedures, we retrospectively reviewed procedures performed by an expert general surgeon in 2007-08 at 2 tertiary hospitals. For each patient, demographic characteristics, procedure type, team members and procedure length were extracted from intraoperative nursing records. We assessed procedure complexity using a calculated index. Multiple logistic regressions were performed to assess the association between procedure length and team size after adjusting for procedure complexity and patient condition.

For the 587 procedures reviewed, the mean procedure length was 88 (standard deviation [SD] 51) minutes. On average, 8 team members (range 4-14), including surgeons, anesthesiologists, nurses and other specialists, were involved in each procedure. Only 47 (8%) procedures were performed by 1 surgeon. Most were performed by 2 (295 [50%]) or 3 surgeons (214 [36%]). Half the team members were nurses (mean 4, range 1-7). Both the complexity of the operation and the team size affected the procedure length significantly. When procedure complexity and patient condition were constant, adding 1 team member predicted a 7-minute increase in procedure length.

This study demonstrates that a frequent change of core team members has a negative impact on surgical performance. Management strategies need to improve to optimize team efficiency in the operating room.