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

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

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.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Cardiac Surgical Procedures / adverse effects
  • Cardiac Surgical Procedures / mortality*
  • Cohort Studies
  • Coronary Artery Bypass / mortality
  • Female
  • Heart Valves / surgery*
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Operating Rooms / organization & administration
  • Patient Care Team / organization & administration*
  • Personnel Staffing and Scheduling*
  • Postoperative Complications
  • Quality Assurance, Health Care*
  • Time Factors
  • Treatment Outcome