Bariatric efficiency at an academic tertiary care center
Background Operating room (OR) efficiency requires coordinated teamwork between the staff surgeon, anesthesia team, circulating nurse, surgical technician, and surgical trainee or assistant. Bariatric cases present unique challenges including difficult airways, challenging intravenous access, use of...
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| Veröffentlicht in: | Surgical endoscopy 2020-06, Vol.34 (6), p.2567-2571 |
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| creator | Lam, Wanda Kim, Gi Yoon Petro, Clayton Alhaj Saleh, Adel Khaitan, Leena |
| description | Background
Operating room (OR) efficiency requires coordinated teamwork between the staff surgeon, anesthesia team, circulating nurse, surgical technician, and surgical trainee or assistant. Bariatric cases present unique challenges including difficult airways, challenging intravenous access, use of specialized surgical equipment, and synchronized exchange of orogastric tubes. The high contribution margin of these complex bariatric procedures rests on OR efficiency.
Objective
To compare the efficiency of bariatric surgeries performed by a single surgeon at a tertiary academic medical center with its inherent variability of OR staff to that of a private hospital with a standardized surgical team.
Methods
All laparoscopic Roux-en-Y gastric bypasses (LRYGB) performed by a single surgeon at University Hospitals Cleveland Medical Center (UHCMC) and a Community Affiliate (CA) from 2013 to 2015 were retrospectively reviewed. Patient demographics and preoperative comorbidities were compared. The variability of OR staff at each site was described. Four primary endpoints of the different OR phases were measured at the 2 locations and analyzed using standard statistical methods.
Results
The OR data of 74 cases of LRYGB at UHCMC and 106 cases at the CA were analyzed. Patient cohorts were comparable by age (45 ± 12
vs.
45 ± 10;
p
=
0.88
), sex (82%
vs.
79% female;
p
=
0.62
), BMI (47.16 ± 7.33
vs.
45.91 ± 6.85;
p
=
0.25
), and comorbidities. At CA, the teams who participated in LRYGB cases were fairly constant (8 circulating and scrub nurses, 4 anesthetists, 3 anesthesiologists), whereas at UHCMC there was great variability in the number of staff with 108 staff (39 circulating nurses, 57 scrub nurses/technicians, 59 anesthetists or anesthesia residents, 24 anesthesiologists) participated in LRYGB cases. There was no statistical difference between the total mean OR time and surgical time of the cases performed at the 2 sites (203 ± 59 min
vs.
188 ± 39 min;
p
=
0.06
; 152 ± 56 min; 145 ± 37 min;
p
=
0.36
). However, the pre- and post-case times were longer at UHCMC compared to the CA (38 ± 9 min
vs.
33 ± 6 min;
p
|
| doi_str_mv | 10.1007/s00464-020-07507-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2384205424</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2384205424</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-d1e68925d1d4d77060ecc7716193c24865923de7f886de1e9e9a82244d955ef23</originalsourceid><addsrcrecordid>eNp9kD1PwzAQhi0EoqXwBxhQJBaWwPlsx_EIFV9SJRaYLWNfUKo2LXYy9N9jaAGJgekk33PvnR_GTjlccgB9lQBkJUtAKEEr0GW1x8ZcCiwReb3PxmAElKiNHLGjlOaQecPVIRsJzIRWfMzqGxdb18fWF9Q0rW-p85vC9YXrCuddoGXu9BT71sVN4V2kwlOXH47ZQeMWiU52dcJe7m6fpw_l7On-cXo9K73Qqi8Dp6o2qAIPMmgNFZD3WvOKG-FR1pUyKALppq6rQJwMGVcjShmMUtSgmLCLbe46rt4HSr1dtsnTYuE6Wg3JoqglgpIoM3r-B52vhtjl6yxKgHyGVCpTuKV8XKUUqbHr2C7z7ywH--nVbr3a7NV-ebVVHjrbRQ-vSwo_I98iMyC2QMqt7o3i7-5_Yj8Az6yAMg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2400892455</pqid></control><display><type>article</type><title>Bariatric efficiency at an academic tertiary care center</title><source>SpringerLink Journals - AutoHoldings</source><creator>Lam, Wanda ; Kim, Gi Yoon ; Petro, Clayton ; Alhaj Saleh, Adel ; Khaitan, Leena</creator><creatorcontrib>Lam, Wanda ; Kim, Gi Yoon ; Petro, Clayton ; Alhaj Saleh, Adel ; Khaitan, Leena</creatorcontrib><description>Background
Operating room (OR) efficiency requires coordinated teamwork between the staff surgeon, anesthesia team, circulating nurse, surgical technician, and surgical trainee or assistant. Bariatric cases present unique challenges including difficult airways, challenging intravenous access, use of specialized surgical equipment, and synchronized exchange of orogastric tubes. The high contribution margin of these complex bariatric procedures rests on OR efficiency.
Objective
To compare the efficiency of bariatric surgeries performed by a single surgeon at a tertiary academic medical center with its inherent variability of OR staff to that of a private hospital with a standardized surgical team.
Methods
All laparoscopic Roux-en-Y gastric bypasses (LRYGB) performed by a single surgeon at University Hospitals Cleveland Medical Center (UHCMC) and a Community Affiliate (CA) from 2013 to 2015 were retrospectively reviewed. Patient demographics and preoperative comorbidities were compared. The variability of OR staff at each site was described. Four primary endpoints of the different OR phases were measured at the 2 locations and analyzed using standard statistical methods.
Results
The OR data of 74 cases of LRYGB at UHCMC and 106 cases at the CA were analyzed. Patient cohorts were comparable by age (45 ± 12
vs.
45 ± 10;
p
=
0.88
), sex (82%
vs.
79% female;
p
=
0.62
), BMI (47.16 ± 7.33
vs.
45.91 ± 6.85;
p
=
0.25
), and comorbidities. At CA, the teams who participated in LRYGB cases were fairly constant (8 circulating and scrub nurses, 4 anesthetists, 3 anesthesiologists), whereas at UHCMC there was great variability in the number of staff with 108 staff (39 circulating nurses, 57 scrub nurses/technicians, 59 anesthetists or anesthesia residents, 24 anesthesiologists) participated in LRYGB cases. There was no statistical difference between the total mean OR time and surgical time of the cases performed at the 2 sites (203 ± 59 min
vs.
188 ± 39 min;
p
=
0.06
; 152 ± 56 min; 145 ± 37 min;
p
=
0.36
). However, the pre- and post-case times were longer at UHCMC compared to the CA (38 ± 9 min
vs.
33 ± 6 min;
p
<
0.0001
; 13 ± 6 min
vs.
10 ± 3 min;
p
=
0.01
).
Conclusion
The academic center has much greater variability in staff for these complex bariatric procedures. There was a trend toward longer OR times at the tertiary center as demonstrated by the difference in pre- and post-case times, but the consistent surgeon and assistant allowed for consistent surgical case time regardless of the setting. The implication of variability in OR staff can be overcome by the surgeon directing the procedure itself. The opportunity for improving the efficiency of bariatric surgery should focus on the perioperative care of the patient in OR that requires everyone to be familiar with the procedure.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-020-07507-6</identifier><identifier>PMID: 32221751</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>2018 SAGES Oral ; Abdominal Surgery ; Anesthesia ; Efficiency ; Gastroenterology ; Gastrointestinal surgery ; Gynecology ; Hepatology ; Medical personnel ; Medicine ; Medicine & Public Health ; Nurses ; Proctology ; Surgeons ; Surgery</subject><ispartof>Surgical endoscopy, 2020-06, Vol.34 (6), p.2567-2571</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020. corrected publication 2020</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020. corrected publication 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-d1e68925d1d4d77060ecc7716193c24865923de7f886de1e9e9a82244d955ef23</citedby><cites>FETCH-LOGICAL-c375t-d1e68925d1d4d77060ecc7716193c24865923de7f886de1e9e9a82244d955ef23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-020-07507-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-020-07507-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32221751$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lam, Wanda</creatorcontrib><creatorcontrib>Kim, Gi Yoon</creatorcontrib><creatorcontrib>Petro, Clayton</creatorcontrib><creatorcontrib>Alhaj Saleh, Adel</creatorcontrib><creatorcontrib>Khaitan, Leena</creatorcontrib><title>Bariatric efficiency at an academic tertiary care center</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Operating room (OR) efficiency requires coordinated teamwork between the staff surgeon, anesthesia team, circulating nurse, surgical technician, and surgical trainee or assistant. Bariatric cases present unique challenges including difficult airways, challenging intravenous access, use of specialized surgical equipment, and synchronized exchange of orogastric tubes. The high contribution margin of these complex bariatric procedures rests on OR efficiency.
Objective
To compare the efficiency of bariatric surgeries performed by a single surgeon at a tertiary academic medical center with its inherent variability of OR staff to that of a private hospital with a standardized surgical team.
Methods
All laparoscopic Roux-en-Y gastric bypasses (LRYGB) performed by a single surgeon at University Hospitals Cleveland Medical Center (UHCMC) and a Community Affiliate (CA) from 2013 to 2015 were retrospectively reviewed. Patient demographics and preoperative comorbidities were compared. The variability of OR staff at each site was described. Four primary endpoints of the different OR phases were measured at the 2 locations and analyzed using standard statistical methods.
Results
The OR data of 74 cases of LRYGB at UHCMC and 106 cases at the CA were analyzed. Patient cohorts were comparable by age (45 ± 12
vs.
45 ± 10;
p
=
0.88
), sex (82%
vs.
79% female;
p
=
0.62
), BMI (47.16 ± 7.33
vs.
45.91 ± 6.85;
p
=
0.25
), and comorbidities. At CA, the teams who participated in LRYGB cases were fairly constant (8 circulating and scrub nurses, 4 anesthetists, 3 anesthesiologists), whereas at UHCMC there was great variability in the number of staff with 108 staff (39 circulating nurses, 57 scrub nurses/technicians, 59 anesthetists or anesthesia residents, 24 anesthesiologists) participated in LRYGB cases. There was no statistical difference between the total mean OR time and surgical time of the cases performed at the 2 sites (203 ± 59 min
vs.
188 ± 39 min;
p
=
0.06
; 152 ± 56 min; 145 ± 37 min;
p
=
0.36
). However, the pre- and post-case times were longer at UHCMC compared to the CA (38 ± 9 min
vs.
33 ± 6 min;
p
<
0.0001
; 13 ± 6 min
vs.
10 ± 3 min;
p
=
0.01
).
Conclusion
The academic center has much greater variability in staff for these complex bariatric procedures. There was a trend toward longer OR times at the tertiary center as demonstrated by the difference in pre- and post-case times, but the consistent surgeon and assistant allowed for consistent surgical case time regardless of the setting. The implication of variability in OR staff can be overcome by the surgeon directing the procedure itself. The opportunity for improving the efficiency of bariatric surgery should focus on the perioperative care of the patient in OR that requires everyone to be familiar with the procedure.</description><subject>2018 SAGES Oral</subject><subject>Abdominal Surgery</subject><subject>Anesthesia</subject><subject>Efficiency</subject><subject>Gastroenterology</subject><subject>Gastrointestinal surgery</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Medical personnel</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Nurses</subject><subject>Proctology</subject><subject>Surgeons</subject><subject>Surgery</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kD1PwzAQhi0EoqXwBxhQJBaWwPlsx_EIFV9SJRaYLWNfUKo2LXYy9N9jaAGJgekk33PvnR_GTjlccgB9lQBkJUtAKEEr0GW1x8ZcCiwReb3PxmAElKiNHLGjlOaQecPVIRsJzIRWfMzqGxdb18fWF9Q0rW-p85vC9YXrCuddoGXu9BT71sVN4V2kwlOXH47ZQeMWiU52dcJe7m6fpw_l7On-cXo9K73Qqi8Dp6o2qAIPMmgNFZD3WvOKG-FR1pUyKALppq6rQJwMGVcjShmMUtSgmLCLbe46rt4HSr1dtsnTYuE6Wg3JoqglgpIoM3r-B52vhtjl6yxKgHyGVCpTuKV8XKUUqbHr2C7z7ywH--nVbr3a7NV-ebVVHjrbRQ-vSwo_I98iMyC2QMqt7o3i7-5_Yj8Az6yAMg</recordid><startdate>20200601</startdate><enddate>20200601</enddate><creator>Lam, Wanda</creator><creator>Kim, Gi Yoon</creator><creator>Petro, Clayton</creator><creator>Alhaj Saleh, Adel</creator><creator>Khaitan, Leena</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20200601</creationdate><title>Bariatric efficiency at an academic tertiary care center</title><author>Lam, Wanda ; Kim, Gi Yoon ; Petro, Clayton ; Alhaj Saleh, Adel ; Khaitan, Leena</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-d1e68925d1d4d77060ecc7716193c24865923de7f886de1e9e9a82244d955ef23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>2018 SAGES Oral</topic><topic>Abdominal Surgery</topic><topic>Anesthesia</topic><topic>Efficiency</topic><topic>Gastroenterology</topic><topic>Gastrointestinal surgery</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Medical personnel</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Nurses</topic><topic>Proctology</topic><topic>Surgeons</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lam, Wanda</creatorcontrib><creatorcontrib>Kim, Gi Yoon</creatorcontrib><creatorcontrib>Petro, Clayton</creatorcontrib><creatorcontrib>Alhaj Saleh, Adel</creatorcontrib><creatorcontrib>Khaitan, Leena</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lam, Wanda</au><au>Kim, Gi Yoon</au><au>Petro, Clayton</au><au>Alhaj Saleh, Adel</au><au>Khaitan, Leena</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Bariatric efficiency at an academic tertiary care center</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2020-06-01</date><risdate>2020</risdate><volume>34</volume><issue>6</issue><spage>2567</spage><epage>2571</epage><pages>2567-2571</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Operating room (OR) efficiency requires coordinated teamwork between the staff surgeon, anesthesia team, circulating nurse, surgical technician, and surgical trainee or assistant. Bariatric cases present unique challenges including difficult airways, challenging intravenous access, use of specialized surgical equipment, and synchronized exchange of orogastric tubes. The high contribution margin of these complex bariatric procedures rests on OR efficiency.
Objective
To compare the efficiency of bariatric surgeries performed by a single surgeon at a tertiary academic medical center with its inherent variability of OR staff to that of a private hospital with a standardized surgical team.
Methods
All laparoscopic Roux-en-Y gastric bypasses (LRYGB) performed by a single surgeon at University Hospitals Cleveland Medical Center (UHCMC) and a Community Affiliate (CA) from 2013 to 2015 were retrospectively reviewed. Patient demographics and preoperative comorbidities were compared. The variability of OR staff at each site was described. Four primary endpoints of the different OR phases were measured at the 2 locations and analyzed using standard statistical methods.
Results
The OR data of 74 cases of LRYGB at UHCMC and 106 cases at the CA were analyzed. Patient cohorts were comparable by age (45 ± 12
vs.
45 ± 10;
p
=
0.88
), sex (82%
vs.
79% female;
p
=
0.62
), BMI (47.16 ± 7.33
vs.
45.91 ± 6.85;
p
=
0.25
), and comorbidities. At CA, the teams who participated in LRYGB cases were fairly constant (8 circulating and scrub nurses, 4 anesthetists, 3 anesthesiologists), whereas at UHCMC there was great variability in the number of staff with 108 staff (39 circulating nurses, 57 scrub nurses/technicians, 59 anesthetists or anesthesia residents, 24 anesthesiologists) participated in LRYGB cases. There was no statistical difference between the total mean OR time and surgical time of the cases performed at the 2 sites (203 ± 59 min
vs.
188 ± 39 min;
p
=
0.06
; 152 ± 56 min; 145 ± 37 min;
p
=
0.36
). However, the pre- and post-case times were longer at UHCMC compared to the CA (38 ± 9 min
vs.
33 ± 6 min;
p
<
0.0001
; 13 ± 6 min
vs.
10 ± 3 min;
p
=
0.01
).
Conclusion
The academic center has much greater variability in staff for these complex bariatric procedures. There was a trend toward longer OR times at the tertiary center as demonstrated by the difference in pre- and post-case times, but the consistent surgeon and assistant allowed for consistent surgical case time regardless of the setting. The implication of variability in OR staff can be overcome by the surgeon directing the procedure itself. The opportunity for improving the efficiency of bariatric surgery should focus on the perioperative care of the patient in OR that requires everyone to be familiar with the procedure.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>32221751</pmid><doi>10.1007/s00464-020-07507-6</doi><tpages>5</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0930-2794 |
| ispartof | Surgical endoscopy, 2020-06, Vol.34 (6), p.2567-2571 |
| issn | 0930-2794 1432-2218 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2384205424 |
| source | SpringerLink Journals - AutoHoldings |
| subjects | 2018 SAGES Oral Abdominal Surgery Anesthesia Efficiency Gastroenterology Gastrointestinal surgery Gynecology Hepatology Medical personnel Medicine Medicine & Public Health Nurses Proctology Surgeons Surgery |
| title | Bariatric efficiency at an academic tertiary care center |
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