Evaluating the Impact of Intraoperative Surgical Team Handoffs on Patient Outcomes. Issue 5 (September 2017)

• Record Type: Journal Article
• Authors: Giugale, Lauren E.; Sears, Sarah; Lavelle, Erin S.; Carter-Brooks, Charelle M.; Bonidie, Michael; Shepherd, Jonathan P.
• Is Part Of: Female pelvic medicine & reconstructive surgery. Volume 23:Issue 5(2017)
• Publication Date: 2017-09
• Subjects: pelvic organ prolapse -- minimally invasive sacrocolpopexy -- handoffs -- surgical outcomes; Pelvis -- Diseases -- Periodicals; Pelvis -- Surgery -- Periodicals; Genital Diseases, Female -- surgery -- Periodicals; Urologic Diseases -- surgery -- Periodicals; Colonic Diseases -- surgery -- Periodicals; Rectal Diseases -- surgery -- Periodicals; Surgical Procedures, Operative -- methods -- Periodicals; 616.6
• DOI: 10.1097/SPV.0000000000000370
• Languages: English
• ISSNs: 2151-8378

Abstract

Abstract : Objective: The aim of the study was to assess the impact of intraoperative personnel handoffs on clinical outcomes in patients undergoing minimally invasive sacrocolpopexy (SCP). Methods: We retrospectively reviewed SCPs performed at an academic center between 2009 and 2014. We analyzed the number of staff handoffs, defined as any instance a scrub technician (tech) or circulating nurse handed off responsibility for a break or shift change. Outcomes included operative (OR) time and composite variables for major complications (conversion to an open procedure, bladder injury, bowel injury, blood transfusion, infection, ileus, bowel obstruction, readmission, or mesh complication) and prolapse recurrence (prolapse at or beyond the hymen or retreatment). Postoperative complications were defined as being within 6 weeks of surgery. Mesh complications and prolapse recurrence were recorded for the entire 68-month study period. Results: Of 814 patients, 97.4% were white, 85.3% postmenopausal, mean (SD) age 59.7 (8.8) years, and mean (SD) body mass index 27.5 (4.5) kg/m 2 . Most had stage 3 prolapse (n = 563, 69.9%). There were 478 (58.7%) laparoscopic and 336 (41.3%) robotic SCPs. The median scrub tech and nurse handoff per case was 1.0 (interquartile range [IQR], 0.0–1.0) and 1.0 (IQR, 1.0–2.0), respectively. Mean (SD) OR time was 204.8 (69.0) minutes. One hundred twenty-nine patients (15.8%) had a major complication and 45 (7.5%) experienced prolapse recurrence over a median follow-up interval of 41.0 weeks (IQR, 12.0–101.0). On multivariable linear regression, each tech and nurse handoff was associated with an increased OR time of 13.6 ( P < 0.001) and 9.4 minutes ( P < 0.001), respectively. Thus, the median of 1 tech and 1 nurse handoff per case will increase OR time by 23.0 minutes (11.2%). On multivariable logistic regression, staff handoffs were not associated with major complications or prolapse recurrence. Conclusions: Intraoperative scrub technician and circulating nurse handoffs increased OR time for minimally invasive SCP procedures. Abstract : Intraoperative scrub technician and circulating nurse handoffs increase operative time for minimally invasive sacrocolpopexy procedures.