Surgical time independently affected by surgical team size

BACKGROUND: Team size and composition provide essential data for the study of operating room (OR) efficiency. METHODS: Laparoscopic procedures between July 2005 and July 2007 were reviewed retrospectively to record the number of OR personnel and the procedure time (PT). RESULTS: Of 399 procedures reviewed, 360 cases with complete data were analyzed. The average PT was 148 minutes. A mean of 8 different team members (range, 4-15) were involved. Surgeons and anesthesiologists stayed constant whereas the OR nurses were replaced more than once per procedure (mean, 4 nurses/procedure; range, 2-11). Multiple regression analysis revealed that both complexity of surgery and team size affected the PT significantly. When procedure complexity and patient condition were held constant, we found that adding 1 individual to a team predicted a 15.4-minutes increase in PT. CONCLUSIONS: The surgical team is a dynamic system with a large amount of member turnover. Efforts to improve OR efficiency should focus on decreasing surgical team size, limiting staff turnover, and enhancing communication between team members. (c) 2009 Elsevier Inc. All rights reserved.