背景:擦洗护士在促进骨科手术中起着至关重要的作用,因此,术中擦洗护士的更替可能会破坏手术团队的工作流程并延长手术时间(DOS)。这项研究的目的是量化术中擦洗护士更替对骨科手术持续时间少于3h的手术时间的影响。
方法:回顾性查询从两个机构收集的数据库,以确定从3月4日起最大平均持续时间为180min的所有骨科手术,2018年8月31日,2022年。病例分为两组,那些有磨砂护士营业额的人和那些没有的人。由外科医生进行倾向评分匹配以匹配组,医院,患者年龄,性别,和ASA分类。使用非配对t检验来比较每个外科手术的平均DOS。计算具有95%置信区间(CI)的治疗(ATET)的平均治疗效果。
结果:对于前臂骨骨折切开复位和内固定(ORIF),磨砂护士的周转显着延长了DOS(ATET=21.08,p=0.001),踝关节ORIF(ATET=21.26,p<0.001),锁骨ORIF(ATET=16.16,p=0.028),股骨髓内钉(ATET=11.52,p=0.003),肩袖修复术(ATET=16.88,p<0.001),椎间盘部分切除术(ATET=10.52,p=0.001),全膝关节置换术(TKA)(ATET=5.69,p<0.001),前全髋关节置换术(THA)(ATET=8.80,p<0.001),外侧THA(ATET=7.02,p<0.001),非骨水泥髋关节置换术(ATET=16.79,p=0.049)。
结论:术中擦洗护士的更替可显着延长骨科手术的手术时间,持续时间长达3小时。这凸显了制定策略以防止术中擦洗护士更替以提高OR效率并降低医疗成本的重要性。
BACKGROUND: Scrub nurses play a crucial role in facilitating orthopaedic surgeries, and thus intraoperative scrub nurse turnover may disrupt the workflow of the surgical team and prolong duration of surgery (DOS). The purpose of this study was to quantify the impact of intraoperative scrub nurse turnover on operative time of orthopaedic surgeries lasting less than 3h in duration.
METHODS: Prospectively collected databases from two institutions were retrospectively queried to identify all orthopaedic procedures of maximum mean duration of 180min from March 4th, 2018 to August 31st, 2022. Cases were divided into two groups, those with scrub nurse turnover and those without. Propensity score matching was conducted to match groups by surgeon, hospital, patient age, gender, and ASA classification. Unpaired t-tests were used to compare mean DOS for each surgical procedure. Average treatment effect on treated (ATET) with 95% confidence intervals (CIs) were calculated.
RESULTS: Scrub nurse turnover significantly prolonged DOS for both bone forearm facture open reduction and internal fixation (ORIF) (ATET=21.08, p=0.001), ankle ORIF (ATET=21.26, p<0.001), clavicle ORIF (ATET=16.16, p=0.028), femur intramedullary nail (ATET=11.52, p=0.003), rotator cuff repair (ATET=16.88, p<0.001), partial discectomy (ATET=10.52, p=0.001), total knee arthroplasty (TKA) (ATET=5.69, p<0.001), anterior total hip arthroplasty (THA) (ATET=8.80, p<0.001), lateral THA (ATET=7.02, p<0.001), and uncemented hip hemiarthroplasty (ATET=16.79, p=0.049).
CONCLUSIONS: Intraoperative scrub nurse turnover significantly prolongs surgical times in orthopaedic surgeries lasting up to 3h in duration. This highlights the importance of developing strategies to prevent intraoperative scrub nurse turnover to improve OR efficiency and decrease healthcare costs.