Good communication among members of the surgical team is critical for intraoperative efficiency and safety. A quality improvement study was conducted at a large tertiary academic medical center to determine how factors such as team turnover, composition, and interpersonal preferences affect intraoperative efficiency.

All 641 primary total joint arthroplasties, including 279 total hip arthroplasties and 362 total knee arthroplasties, performed in a single year were included in the analysis.

Turnover among operative staff, particularly circulating nurses, was associated with an increased operative duration. For total hip arthroplasties, each additional circulating nurse was associated with a mean expected increase of 14.8 minutes in incision time, 17.5 minutes in procedure time, and 19.6 minutes in overall room time. Similarly, for total knee arthroplasties, each additional circulating nurse was associated with a mean expected increase of 10.2 minutes in incision time, 11.8 minutes in procedure time, and 14 minutes in overall room time. The presence of nonresident trainees wasn't associated with increases in operative duration for either total hip arthroplasties or total knee arthroplasties. In some cases, the presence of residents was associated with significantly reduced operative time. The presence of a preferred vendor was associated with an expected increase in room time for both total hip arthroplasties and total knee arthroplasties (26.3 minutes and 29.6 minutes, respectively).

The study was conducted in just one medical center, which limits the generalizability of the results, the authors note. Also, because the analysis was retrospective, only associative rather than causative conclusions about variables could be drawn. Finally, the authors only assessed operative duration as a marker of operative efficiency and therefore were not able to quantify postoperative outcomes, such as readmissions or surgical site infections.