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01-12-2018

High-resolution standardization reduces delay due to workflow disruptions in laparoscopic cholecystectomy

Authors: Marco von Strauss und Torney, Sohelia Aghlmandi, Jasmin Zeindler, Debora Nowakowski, Christian A. Nebiker, Christoph Kettelhack, Rachel Rosenthal, Raoul A. Droeser, Savas D. Soysal, Henry Hoffmann, Robert Mechera

Published in: Surgical Endoscopy | Issue 12/2018

Abstract

Background

Optimal resource utilization in high-cost environments like operating theatres is fundamental in today’s cost constrained health care systems. Interruptions of the surgical workflow, i.e. microcomplications (MC), lead to prolonged procedure times and higher costs and can be indicative of surgical mistakes. Reducing MC can improve operating room efficiency and prevent intraoperative complications. We, therefore, aimed to evaluate the impact of a high-resolution standardized laparoscopic cholecystectomy protocol (HRSL) on operative time and intraoperative interruptions in a teaching hospital.

Methods

HRSL consisted of a detailed stepwise protocol for the procedure, supported by a teaching video, both to be reviewed as mandatory preparation by each team member before surgery. Audio–video records of laparoscopic cholecystectomies were reviewed regarding type, frequency and duration of MC before and after implementation of HRSL.

Results

Thirty-nine (20 control and 19 HRSL) audio–video records of laparoscopic cholecystectomies with a total duration of 51.36 h (28.92 pre 22.44 post) were reviewed. The majority of operations (86%) were performed by teams who had completed less than 10 procedures together previously. Communication-related interruptions and instrument changes accounted for the majority of MC. Median frequency and duration of MC were 95 events/h and 15.6 min/h, respectively, of surgery pre-intervention. With HRSL this was reduced to 76 events/h and 10.6 min/h of operating. In multivariable analysis, HRSL was an independent predictor for shorter delay and lower frequency of MC [percentage decrease 27% (95% CI 18–35%), resp. 30% (95% CI 19–40%)]. Procedure-related risk factors for the longer delay due to MC in multivariable analysis were less experience of the surgeon and intraoperative adhesiolysis.

Conclusions

HRSL is effective in reducing delays due to MC in a teaching institution with limited team experience. These findings should be tested in larger potentially cluster-randomized controlled trials.

The trial has been registered with clinicaltrials.gov: NCT03329859.

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Title: High-resolution standardization reduces delay due to workflow disruptions in laparoscopic cholecystectomy
Authors: Marco von Strauss und Torney
Sohelia Aghlmandi
Jasmin Zeindler
Debora Nowakowski
Christian A. Nebiker
Christoph Kettelhack
Rachel Rosenthal
Raoul A. Droeser
Savas D. Soysal
Henry Hoffmann
Robert Mechera
Publication date: 01-12-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 12/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6224-y

At a glance: The STEP trials

Springer Medicine

High-resolution standardization reduces delay due to workflow disruptions in laparoscopic cholecystectomy

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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