title: Surgical team composition has a major impact on effectiveness and costs in laparoscopic donor nephrectomy.
abstract: OBJECTIVE
  Limited evidence exists that optimization of surgical team composition may improve effectiveness of laparoscopic donor nephrectomy (LDN).
  
  
  METHODS
  A retrospective cohort study with 541 consecutive LDNs. From 2003 to 2012, surgical team composition was gradually optimized with regard to the surgeons' experience, proficient assistance and the use of fixed teams.
  
  
  RESULTS
  Multivariable analysis showed that a surgical team with an experienced surgeon had a significantly shorter operation time (OT) (-18 min, 95% CI -28 to -9), less estimated blood loss (EBL) (-64 mL, 95% CI -108 to -19) and shorter length of stay (LOS) (-1 day, 95% CI -1.6 to 0). Proficient assistance was also independently associated with a shorter OT (-43 min, 95% CI -53 to -33) and reduced EBL (-58 mL, 95% CI -109 to -6), whereas those procedures performed by fixed teams were related to a shorter operation (-50 min, 95% CI -59 to -43) and warm ischemia time (-1.8, 95% CI -2.1 to -1.5), a reduced mean complication grade (-0.14 per patient, 95% CI -0.3 to -0.02) and a shorter LOS (-1.1 day, 95% CI -1.7 to -05). Health care costs for LDN by one staff surgeon with unproficient assistance were 7.707 Euro, whereas costs for LDN by two staff surgeons in fixed teams were 5.614 Euro.
  
  
  CONCLUSIONS
  Surgical team composition has a major impact on variables that reflect the effectiveness of LDN from the donors' perspective. Health care costs are lower for LDNs performed by two experienced surgeons in fixed team composition. We advocate the use of two experienced surgeons in fixed team composition for LDN.
authors.affiliation: Division of Vascular and Transplant Surgery, Department of Surgery, Radboud University Nijmegen Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands, denise.ozdemir-vanbrunschot@radboudumc.nl.
authors.forename: Denise M D
authors.initials: DM
authors.lastname: Özdemir-van Brunschot
authors.forename: Michiel C
authors.initials: MC
authors.lastname: Warlé
authors.forename: Michel F
authors.initials: MF
authors.lastname: van der Jagt
authors.forename: Janneke P C
authors.initials: JP
authors.lastname: Grutters
authors.forename: Sharon B C E
authors.initials: SB
authors.lastname: van Horne
authors.forename: Heinrich J
authors.initials: HJ
authors.lastname: Kloke
authors.forename: Johannes A
authors.initials: JA
authors.lastname: van der Vliet
authors.forename: Johan F
authors.initials: JF
authors.lastname: Langenhuijsen
authors.forename: Frank C
authors.initials: FC
authors.lastname: d'Ancona
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D016030:Kidney Transplantation / Q000191:economics*; D007828:Laryngoscopy / Q000191:economics*; D007902:Length of Stay / Q000706:statistics & numerical data; D019520:Living Donors; D008297:Male; D008503:Medical Staff / Q000592:standards*; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000191:economics*; D009426:Netherlands; D061646:Operative Time; D011361:Professional Competence / Q000592:standards*; D012189:Retrospective Studies; D016896:Treatment Outcome