Order of Surgical Procedures Affects Operating Time

A new study suggests that there is a robust relationship between operating list composition and surgical performance, as indexed by total operating time.

Researchers at the University of Leeds (United Kingdom) collected operating theatre lists involving the 35 procedures performed most frequently by senior surgeons across 38 private hospitals in the United Kingdom during a period of 26 months, in order to understand the relationship between case list order and operative performance. The researchers estimated the impact of list order, the cost of switching between procedures on a list, the influence of procedure method (open versus minimally invasive), and the significance of technical complexity.

In all, the study included 255,757 procedures, allowing a matched analysis 48,632 pairs of procedures. The results revealed that repeating the same procedure in a list resulted in shorter operating times for each increase in list position. Conversely, switching between procedures increased overall duration by an average of 6.48%. The overall reduction in operating time from completing the same procedure immediately was 6.18%, which remained consistent across procedure method and complexity. The study was published on March 20, 2018, in BJS.

“This study demonstrates the existence of a natural 'warm-up' effect as surgeons work their way through their operating lists. Reductions in operating time come from repeating the same procedure, but this saving is lost when surgeons are asked to perform a different type of procedure on the same list,” said study co-author Faisal Mushtaq, MD. “These data present an important development in our understanding of how to optimize surgical performance.”

By standardizing performance via checklists, surgeons can reduce reliance on memory, and thus reduce errors of omission. This is particularly applicable to healthcare as processes become more complex, staff becomes busier, and handovers and shift working become more common. Checklists contribute to team communication and working and increase situational awareness among team members, but successful adoption requires careful implementation to make sure that the checklist is used effectively.

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