| Title |
High-resolution standardization reduces delay due to workflow disruptions in laparoscopic cholecystectomy
|
|---|---|
| Published in |
Surgical Endoscopy, May 2018
|
| DOI | 10.1007/s00464-018-6224-y |
| Pubmed ID | |
| 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 |
| Abstract |
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. 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. 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. 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. |
Mendeley readers
The data shown below were compiled from readership statistics for 45 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 45 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Ph. D. Student | 6 | 13% |
| Researcher | 6 | 13% |
| Student > Bachelor | 6 | 13% |
| Student > Master | 5 | 11% |
| Student > Doctoral Student | 3 | 7% |
| Other | 6 | 13% |
| Unknown | 13 | 29% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 16 | 36% |
| Engineering | 3 | 7% |
| Nursing and Health Professions | 3 | 7% |
| Arts and Humanities | 2 | 4% |
| Psychology | 2 | 4% |
| Other | 2 | 4% |
| Unknown | 17 | 38% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 10 July 2018.
All research outputs
#20,527,576
of 23,096,849 outputs
Outputs from Surgical Endoscopy
#5,733
of 6,123 outputs
Outputs of similar age
#289,886
of 330,249 outputs
Outputs of similar age from Surgical Endoscopy
#96
of 100 outputs
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