title: Evaluating the Impact of Intraoperative Surgical Team Handoffs on Patient Outcomes.
abstract: The aim of the study was to assess the impact of intraoperative personnel handoffs on clinical outcomes in patients undergoing minimally invasive sacrocolpopexy (SCP).
  
  
  
  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.
  
  
  
  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. 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.
  
  
  
  Intraoperative scrub technician and circulating nurse handoffs increased OR time for minimally invasive SCP procedures.
authors.affiliation: From the *Department of Obstetrics, Gynecology & Reproductive Sciences of Magee-Womens Hospital of UPMC, Magee-Womens Research Institute; and †University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Giugale
authors.forename: Sarah
authors.initials: S
authors.lastname: Sears
authors.forename: Erin S
authors.initials: ES
authors.lastname: Lavelle
authors.forename: Charelle M
authors.initials: CM
authors.lastname: Carter-Brooks
authors.forename: Michael
authors.initials: M
authors.lastname: Bonidie
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Shepherd
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008875:Middle Aged; D009873:Operating Rooms; D061646:Operative Time; D062209:Patient Handoff / Q000191:economics / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000706:statistics & numerical data*; D013526:Surgical Mesh / Q000009:adverse effects; D014596:Uterine Prolapse / Q000601:surgery*