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.