Real‐time analysis of intraoperative delays and variations in intraoperative workflow with level of experience of the primary surgeon in small animal surgery

Abstract

Objective: To describe the causes of intraoperative delays and the changes in delays and surgical workflow with the level of training of the primary surgeon.Study design: Prospective observational study.Sample population: Seventy-three small animal surgical procedures performed at an academic teaching institution between January 17, 2018 and April 10, 2018. Methods: Procedures (trainee = 37, faculty = 36) totaling 103.2 h were observed and video recorded. Operative time was allocated to the surgical approach, exploration, exposure, intervention, and closure phases. Suballocations were made to specific tasks within these categories (such as cutting or hemostasis). Intraoperative delays and reasons were recorded. Differences in use of time between trainee and faculty surgeons were analyzed.Results: Delays constituted 9.2% (±4.4) of the operative time, of which 6.5% (±3.6) were surgeon controlled and 2.6% (±2.7) were non-surgeon controlled.Surgeons preparing instrumentation outside of the operative field and retrieval of equipment from supply areas were the greatest contributors to delays. Intraoperative delays did not increase when the trainee was placed in the primary surgeon role (P = .78). During the approach faculty surgeons spent proportionally less time on hemostasis (P = .02), and during closure they spent less time suturing (P = .03) than trainees. Conclusion:Trainee surgeons did not have greater intraoperative delays. Delays were created when surgeons prepared their own instrumentation.Workflow differed between experts and trainees. Clinical significance: Advancing a trainee surgeon into the primary role is unlikely to increase intraoperative delays, which can be reduced by the inclusion of trained scrub technicians. A focus on efficient hemostasis and fluidity when suturing may improve operative efficiency for surgical trainees.

Hydrodissection to create conjunctival flaps in dogs with corneal ulcers

“…Medians followed by the same letter do not differ from each other according to Wilcoxon's test at p = 0.39 fatigue, may prolong the operative duration [28]. However, it should be noted that the procedures were performed by the same veterinary surgeon who earned his degree from the Brazilian College of Veterinary Ophthalmology and whose learning curve in this technique has reached a plateau, thus minimizing this type of influence on the results of this research.…”

“…The operative time spent in the construction of conjunctival flaps in normal dogs was analyzed, and no change was observed [ 21 ]. Several factors, such as pre-operative planning, surgeon experience, and fatigue, may prolong the operative duration [ 28 ]. However, it should be noted that the procedures were performed by the same veterinary surgeon who earned his degree from the Brazilian College of Veterinary Ophthalmology and whose learning curve in this technique has reached a plateau, thus minimizing this type of influence on the results of this research.…”