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Ann Surg. 2011 Feb;253(2):385-92. doi: 10.1097/SLA.0b013e3182061c69.

Can the impact of change of surgical teams in cardiovascular surgery be measured by operative mortality or morbidity? A propensity adjusted cohort comparison.

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1
Division of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, AB, Canada.

Abstract

OBJECTIVE:

Our objective was to examine the impact of team changeover and unfamiliar teams in cardiovascular surgery on traditional clinical outcome measures.

BACKGROUND:

The importance of teamwork in the operating room is increasingly being appreciated, but the impact on more traditional outcome measures is unclear.

METHODS:

Elective or urgent cardiovascular procedures were divided into categories: team D (patients who had an operation with a day team); team E (patients who had an operation with an evening team); team C (patients who had an operation which included changeover between a day and evening team). Comparison groups were adjusted using propensity scores.

RESULTS:

We identified 6698 patients who met inclusion criteria (team D, n =3781; team E, n = 518; team C, n = 2399). After propensity score adjustment,there was an increased skin–skin time of 28 minutes in team C when compared with team D (P < 0.001) and of 21 minutes when compared with team E (P <0.001). There were also more episodes of septicemia among team C patients(OR 1.85, P = 0.013) when compared with team D. Patients operated by a day team had a statistically significantly lower number of ventilated hours and shorter hospital length of stay when compared with team E and team C (P < 0.001 and P < 0.001, respectively). There was no difference between teams in operative death, reoperation for bleeding, blood transfusion, renal failure/dialysis, neurologic events, or deep/superficial wound infections.

CONCLUSIONS:

The change in operating room personnel from the day team to the evening team added significant length to the total operating department time in cardiovascular surgery; however, its impact on most traditional outcome measures was difficult to demonstrate. More sensitive outcome measures may be required to assess the impact of teamwork interventions.

PMID:
21173693
DOI:
10.1097/SLA.0b013e3182061c69
[Indexed for MEDLINE]
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