title: Surgical team turnover and operative time: An evaluation of operating room efficiency during pulmonary resection.
abstract: OBJECTIVE
  Health care resources are costly and should be used judiciously and efficiently. Predicting the duration of surgical procedures is key to optimizing operating room resources. Our objective was to identify factors influencing operative time, particularly surgical team turnover.
  
  
  METHODS
  We performed a single-institution, retrospective review of lobectomy operations. Univariate and multivariate analyses were performed to evaluate the impact of different factors on surgical time (skin-to-skin) and total procedure time. Staff turnover within the nursing component of the surgical team was defined as the number of instances any nurse had to leave the operating room over the total number of nurses involved in the operation.
  
  
  RESULTS
  A total of 235 lobectomies were performed by 5 surgeons, most commonly for lung cancer (95%). On multivariate analysis, percent forced expiratory volume in 1 second, surgical approach, and lesion size had a significant effect on surgical time. Nursing turnover was associated with a significant increase in surgical time (53.7 minutes; 95% confidence interval, 6.4-101; P = .026) and total procedure time (83.2 minutes; 95% confidence interval, 30.1-136.2; P = .002).
  
  
  CONCLUSIONS
  Active management of surgical team turnover may be an opportunity to improve operating room efficiency when the surgical team is engaged in a major pulmonary resection.
authors.affiliation: Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Alain Joe
authors.initials: AJ
authors.lastname: Azzi
authors.affiliation: Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Karan
authors.initials: K
authors.lastname: Shah
authors.affiliation: Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Seely
authors.affiliation: Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: James Patrick
authors.initials: JP
authors.lastname: Villeneuve
authors.affiliation: Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Sudhir R
authors.initials: SR
authors.lastname: Sundaresan
authors.affiliation: Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Farid M
authors.initials: FM
authors.lastname: Shamji
authors.affiliation: Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Donna E
authors.initials: DE
authors.lastname: Maziak
authors.affiliation: Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Electronic address: sgilbert@toh.on.ca.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gilbert
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D017598:Efficiency, Organizational; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009864:Ontario; D009873:Operating Rooms / Q000458:organization & administration*; D061646:Operative Time; D010348:Patient Care Team / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling; D010563:Personnel Turnover / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D000078329:Workforce
keywords: efficiency; health economics; lung surgery; management; staff turnover; surgical quality