A Standardized Operative Team for Major Head and Neck Cancer Ablation and Reconstruction

Authors:
  • SNSteven C. Nakoneshny
    Steven C. Nakoneshny
  • AHAllan R. Harrop
    Allan R. Harrop
  • TMT. Wayne Matthews
    T. Wayne Matthews
  • CSChristiaan Schrag
    Christiaan Schrag
  • DMDavid C. McKenzie
    David C. McKenzie
  • WHWilliam De Haas
    William De Haas
  • RDRoger B. Davis
    Roger B. Davis
  • JDJoseph C. Dort
    Joseph C. Dort
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Abstract
Background: Prolonged procedure time in head and neck cancer ablation and free flap reconstruction cases has been shown to significantly increase perioperative complications. The authors' objective was to evaluate the effectiveness of a standardized surgical nursing team for head and neck cancer ablation and free flap reconstruction operations for reducing procedure time. Methods: A retrospective cohort analysis of consecutive patients presenting for head and neck cancer ablation and free flap reconstruction between January 1, 2007, and September 1, 2010, was performed. A standardized head and neck surgical nursing team was introduced on May 1, 2009, at our center. Procedure time and case time were measured before and after the introduction of the team. Univariable analyses were performed to evaluate the difference in procedure and case time between the two cohorts. A multivariable linear regression model was developed to control for confounding variables. Results: There were 52 cases before the team was introduced and 49 cases after. Mean procedure time was reduced by 47.1 minutes (p = 0.04) and mean case time was reduced by 68.9 minutes (p = 0.01) after team introduction. The multivariable linear regression analysis demonstrated a significant reduction in operative time after team introduction, controlling for confounding variables. Conclusions: The introduction of a standardized surgical nursing team led to a significant reduction in procedure and case time. A standardized team approach improves operating room efficiency in complex cases such as free flap reconstruction following tumor ablation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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