title: The impact of team familiarity and surgical experience on operative efficiency: a retrospective analysis.
abstract: OBJECTIVE
  The independent impact of individual surgical experience and team familiarity on surgical performance has been widely studied; however, the interplay of these factors and their relative, quantified, contributions to performance is poorly understood. We determined the impact of team familiarity and surgeon, and cumulative team experience on operative efficiency in total knee replacement.
  
  
  METHODS
  Retrospective analysis of all total knee replacements conducted at the host institution in 1996-2009. Multivariate generalised-estimating-equation regression models were used to adjust for patient risk and clustering.
  
  
  METHODS
  Tertiary care academic hospital.
  
  
  METHODS
  All patients undergoing TKR at the host institution in 1996-2009.
  
  
  METHODS
  Operative efficiency.
  
  
  RESULTS
  A total of 4276 total knee replacements were completed by 1163 different surgical teams. The median experience level was 17.6 years for consultant surgeons and 3.7 years for trainee surgeons. After patient-risk adjustment, consultant surgical experience (p < 0.0001), trainee surgical experience (p < 0.05), cumulative team operative experience (p < 0.0001) and team familiarity (p < 0.0001) were associated with significant reductions in operative time. Surgical experience and team familiarity demonstrated concave and linear relationships with operative time, respectively. For a consultant surgeon, the expected reduction in operative time after 25 years in practice was 51 min, compared to a 21-min reduction over the span of 40 collaborations with the same team members.
  
  
  CONCLUSIONS
  Surgical experience and team familiarity display important and distinct relationships with operative time in total knee replacement. Appreciation of this interplay may serve to guide implementation and allocation of procedure-specific quality improvement strategies in surgery.
authors.affiliation: Harvard University, Cambridge, MA, USA.
authors.forename: Mahiben
authors.initials: M
authors.lastname: Maruthappu
authors.affiliation: Université de Lyon, Lyon, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Duclos
authors.affiliation: University of Oxford, Oxford, UK.
authors.forename: Charlie D
authors.initials: CD
authors.lastname: Zhou
authors.affiliation: Harvard Medical School, Boston, MA, USA.
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.affiliation: Harvard Medical School, Boston, MA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Wright
authors.affiliation: Harvard Medical School, Boston, MA, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Orgill
authors.affiliation: Harvard Medical School, Boston, MA, USA mcarty@partners.org.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Carty
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D002983:Clinical Competence; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000592:standards*; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000592:standards*; D019984:Quality Indicators, Health Care; D012044:Regression Analysis; D012189:Retrospective Studies; D013043:Specialties, Surgical / Q000592:standards; D000267:Tissue Adhesions
keywords: Learning curve; collaboration; operative efficiency; performance curve; teamwork; total knee replacement