Intraoperative scrub nurse turnover in orthopaedic surgery procedures: An opportunity for improved operating room efficiency

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).

CONCLUSION

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.

Reflections on current methods for evaluating skills during joint replacement surgery

Valid and reliable techniques for assessing performance are essential to surgical education, especially with the emergence of competency-based frameworks. Despite this, there is a paucity of adequate tools for the evaluation of skills required during joint replacement surgery. In this scoping review, we examine current methods for assessing surgeons’ competency in joint replacement procedures in both simulated and clinical environments. The ability of many of the tools currently in use to make valid, reliable and comprehensive assessments of performance is unclear. Furthermore, many simulation-based assessments have been criticised for a lack of transferability to the clinical setting. It is imperative that more effective methods of assessment are developed and implemented in order to improve our ability to evaluate the performance of skills relating to total joint replacement. This will enable educators to provide formative feedback to learners throughout the training process to ensure that they have attained core competencies upon completion of their training. This should help ensure positive patient outcomes as the surgical trainees enter independent practice.

Cite this article: Bone Joint J 2013;95-B:1445–9.

Influence of the number of cortices on the stiffness of plate fixation of diaphyseal fractures

OBJECTIVE

To determine the influence of the number of cortices of fixation on the stiffness of plate fixation of diaphyseal fractures.

DESIGN

Canine experimental study.

SETTING

Tertiary referral and teaching hospital in Toronto, Canada.

PARTICIPANTS

Paired radii from fourteen skeletally mature, cross-bred dogs.

MAIN OUTCOME MEASURE

One member of each pair of radii was tested intact as a control, and the other had a transverse osteotomy plated sequentially with five to ten cortices of fixation on either side of the simulated fracture. Dynamic compression plates and limited contact dynamic compression plates were used in two groups with seven paired radii each. Normalized torsional stiffness and four-point bending stiffness were determined in the elastic range for the control and each of the plated constructs in both groups, using a materials testing machine.

RESULTS

The authors found no significant difference between the stiffness of the dynamic compression plates and limited contact dynamic compression plates. With either plate of a given length, significantly increased torsional stiffness is achieved with end bicortical screws. For bending stability with the plate at right angles to the bending plane, even short plated constructs have a stiffness exceeding that of intact bone.

CONCLUSIONS

For a transverse osteotomy with no fracture interdigitation, the bending rigidity with the plate at right angles to the bending plane is greater than the original stiffness of the bone for all constructs tested, with the exception of the limited contact dynamic compression plate with five cortices of fixation. The torsional rigidity of fixation only approaches the original rigidity of the bone for ten cortices of fixation with the dynamic compression plate and the limited contact dynamic compression plate.

Characterization of exoskeletal proteins from the American lobster, Homarus americanus

Proteins from the calcified exoskeleton of the lobster, Homarus americanus, were extracted and separated by two-dimensional gel-electrophoresis. Electroblotting the proteins onto polyvinylidene difluoride (PVDF) membranes followed by sequence determination gave 16 N-terminal amino-acid sequences and revealed that further eight proteins were N-terminally blocked. The relative molecular mass, M(r), was obtained for most of the electrophoretically separated proteins by means of matrix-assisted laser desorption mass spectrometry (MALDIMS) after electroelution from Coomassie-stained two-dimensional polyacrylamide gels. Eleven proteins were purified from extracts of the exoskeleton by low pressure ion exchange chromatography and reversed-phase high performance chromatography, and their sequences were determined by combined use of Edman degradation and mass spectrometry. Good agreement was obtained between the M(r)-values measured by mass spectrometry and those calculated from the sequences. Five of the sequenced proteins contain two copies of a previously observed 18-residue sequence motif, while a couple of the remaining sequences show similarity to sequences of exoskeletal proteins from shrimps and spiders. Only limited similarity to insect cuticular proteins was observed.

Moisture and mould problems in schools and respiratory manifestations in schoolchildren: clinical and skin test findings

OBJECTIVE

We performed a clinical study in 99 children attending schools with moisture problems and compared the findings with those of 34 children from a reference school. The aim of the study was to evaluate the possible association between respiratory or allergic diseases in the pupils and moisture or mould problems in the school buildings.

RESULTS

Asthma was diagnosed in nine (6.7%) children: eight of them came from the moisture-problem schools and all were over 10 y old. In addition, 17 non-asthmatic children had suffered from wheezing and 21 from long-term cough, both symptoms being suggestive of occult asthma. If moisture problems were observed both at home and in the school, the frequency of asthma was 21% and the combined frequency of asthma and wheezing was 43%. The presence of allergic rhinoconjuntivitis or atopic dermatitis had no association with moisture or mould problems. We performed skin-prick tests to 13 moulds in all the 133 children. A positive reaction (> 3 mm) was observed in only six (5%) of them. All six positive children reacted to at least one moisture-indicative mould, Fusarium roseum, Aspergillus fumigatus, Phoma herbarum or Rhodotorula rubra. None of these cases came from the reference school. There was a significant association between positive reactions to moisture-indicative moulds and asthma; four (44%) of the nine children with asthma had such reactions. In addition, all the 6 reactive children had either asthma or wheezing.

CONCLUSIONS

We report preliminary evidence for an association between moisture or mould problems in the school building and the presence of manifest and occult asthma in the pupils. Our results show that skin-test positivity to moulds is rare in children. However, reactivity to moisture-indicative moulds seems to be associated with the occurrence of asthma or wheezing.