Operating Room Personnel Research Articles

Factors Affecting Occupational Hazards among Operating Room Personnel at Hospitals Affiliated in Western Iran: A Cross-Sectional Study

Occupational hazards are among the major health problems worldwide, and there is the possibility of occurrence of accidents in all workplaces. Hospitals are one of the most vulnerable places in this regard. Therefore, the present study aimed to investigate factors affecting occupational hazards among operating room personnel at hospitals affiliated to Kermanshah University of Medical Sciences in 2018. In this descriptive-analytic research, 435 operating room personnel at hospitals affiliated to Kermanshah University of Medical Sciences were chosen selected through quota sampling and studied in 2018. The data collection tool was a two-part questionnaire, the first part containing the demographic information, and the second part consisting of 29 questions relating to occupational hazards. For data analysis, descriptive (frequency, percentage, mean and standard deviation) and inferential statistics (ANOVA and independent t-test) and SPSS statistical software version 23.0 were employed. The significance level was set at p < 0.05. The level of occupational hazards was evaluated as high, with a mean and standard deviation of 3.12 ± 0.45. Among the dimensions of occupational hazards, ergonomic and biological hazards were reported as the most and least important occupational hazards (3.22 ± 0.71 and 3.04 ± 0.64, respectively). Moreover, the mean of the total score of occupational hazards significantly correlated with each of the variables of age, marital status, education, work experience, organizational position, shifts, employment status and hospital, but not for gender (p < 0.05). The results of the present study demonstrated that the most significant occupational injuries among the operating room personnel under study were the result of ergonomic hazards. Therefore, given the factors affecting the increase of these injuries, it is highly recommended that a committee be formed by the operating room personnel to eliminate these harmful aspects to determine occupational injuries in hospitals with the aim of changing the working conditions and environment and, finally, developing health promotion programs towards creating a safe working environment in operating rooms.

Several suggestion of operation for colorectal cancer under the outbreak of Corona Virus Disease 19 in China

Pneumonia caused by SARS-Cov-2 infection has been reported in Wuhan since December 2019, and spread rapidly across the country. The radical operation of colorectal cancer is confine operation. Patients with colorectal cancer should receive operation as soon as possible after elective operation is resumed in each hospital. SARS-Cov-2 virus can be transmitted by asymptomatic infectors, and it has been confirmed to be transmitted by droplets and contact. However, fecal-oral transmission and aerosol transmission have not been excluded. Based onLaparoscopic colorectal operation experiences, the author suggests that the surgery strategy for colorectal cancer patients under the COVID-19 situation. Recommending laparoscopy-assisted radical surgery for colorectal cancer patients. The aerosols need to be strictly managed during operation. NOSES and TaTME should be carried out with cautious during the epidemic period. Protective stoma should be carried out scientifically and reasonably, and the protection of operating room personnel should be strengthened.

Virtual reality operating room with AI guidance: design and validation of a fire scenario.

Operating room (OR) fires are uncommon but disastrous events. Inappropriate handling of OR fires can result in injuries, even death. Aiming to simulate OR fire emergencies and effectively train clinicians to react appropriately, we have developed an artificial intelligence (AI)-based OR fire virtual trainer based on the principle of the "fire triangle" and SAGES FUSE curriculum. The simulator can predict the user's actions in the virtual OR and provide them with timely feedback to assist with training. We conducted a study investigating the validity of the AI-assisted OR fire trainer at the 2019 SAGES Learning Center. Fifty-three participants with varying medical experience were voluntarily recruited to participate in our Institutional Review Board approved study. All participants were asked to contain a fire within the virtual OR. Participants were then asked to fill out a 7-point Likert questionnaire consisting of ten questions regarding the face validation of the AI-assisted OR fire simulator. Shapiro-Wilk tests were conducted to test normality of the scores for each trial. A Friedman's ANOVA with post hoc tests was used to evaluate the effect of multiple trials on performance. On a 7-point scale, eight of the ten questions were rated a mean of 6 or greater (72.73%), especially those relating to the usefulness of the simulator for OR fire-containing training. 79.25% of the participants rated the degree of usefulness of AI guidance over 6 out of 7. The performance of individuals improved significantly over the five trials, χ2(4) = 119.89, p < .001, and there was a significant linear trend of performance r = .97, p = 0.006. A pairwise analysis showed that only after the introduction of AI did performance improve significantly. The AI-guided OR fire trainer offers the potential to assess OR personnel and teach the proper response to an iatrogenic fire scenario in a safe, repeatable, immersive environment.

Characterization of smoke generated during the use of surgical knife in laparotomy surgeries

ABSTRACTThe staff in hospitals is the high-risk group affected by indoor air pollution for operational reasons. However, there is a lack of relevant information and research on surgical smoke in Taiwan. This study analyses the substance of the smoke and develops relative strategies to prevent harm from the working place. This study aims to evaluate the surgical smoke generated during laparotomy and laparoscopic operation. The relationship between smoke and the risk of health-care workers was also discussed in order to set suitable solutions for smoke collection and emission. The study measured surgical smoke of 30 cases in operating rooms in three different hospitals, smoke was collected at different timings and different areas during the operation using a low-flow sampler. The concentration and accumulation number of size 0.3 μm suspended particles were the highest among all size of particles in different detection areas and timing. The concentration number of 0.3 μm and 0.5 μm particles reached the maximum after 10 min of electrosurgical treatment; however, the concentration number of 5 μm particles began to decrease after 5–15 min of the treatment. Besides, the cumulative particle numbers of 0.3 μm and 0.5 μm in laparoscopic operation were higher than those of laparotomy after 10 min of the treatment. This study suggests that surgical smoke prevention should use smoke evacuator; health-care workers should also wear a highly efficient tight seal-fit mask in the operating room to avoid damage to their health and cause chronic diseases.Implications: Indoor air pollution in medical institutions is a topic of less concern, and the health of healthcare workers is threatened by surgical smoke that generated during operations. This study measured and analyzed the harmful substances in the surgical smoke in the operating rooms of hospitals, and put forward the corresponding suggestions. In April 2018, legislators in Taiwan also convened a seminar on “Respiratory protection for operating room personnel in medical institutions”. The seminar applied the findings of this study and adopted the recommendations to improve related equipment and strategies in future plans.

Surgeon and staff radiation exposure in minimally invasive spinal surgery: prospective series using a personal dosimeter.

The level of radiation awareness by surgeons and residents in spinal surgery does not match the ubiquity of fluoroscopy in operating rooms in the United States. The present method of monitoring radiation exposure may contribute to the current deficiency in radiation awareness. Current dosimeters involve a considerable lag from the time that the surgical team is exposed to radiation to the time that they are provided with that exposure data. The objective of the current study was to assess the feasibility of monitoring radiation exposure in operating room personnel during lateral transpsoas lumbar interbody fusion (LLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) procedures by using a wearable personal device with real-time feedback. Operating room staff participating in minimally invasive surgical procedures under a single surgeon during a 6-month period were prospectively enrolled in this study. All radiation dose exposures were recorded for each member of the surgical team (surgeon, assistant surgeon, scrub nurse, and circulating nurse) using a personal dosimeter (DoseAware). Radiation doses were recorded in microsieverts (μSv). Comparisons between groups were made using ANOVA with the Tukey post hoc test and Student t-test. Thirty-nine patients underwent interbody fusions: 25 underwent LLIF procedures (14 LLIF alone, 11 LLIF with percutaneous screw placement [PSP]) and 14 underwent MI-TLIF. For each operative scenario per spinal level, the surgeon experienced significantly higher (p < 0.035) average radiation exposure (LLIF: 167.9 μSv, LLIF+PSP: 424.2 μSv, MI-TLIF: 397.9 μSv) than other members of the team, followed by the assistant surgeon (LLIF: 149.7 μSv, LLIF+PSP: 242.3 μSv, MI-TLIF: 274.9 μSv). The scrub nurse (LLIF: 15.4 μSv, LLIF+PSP: 125.7 μSv, MI-TLIF: 183.0 μSv) and circulating nurse (LLIF: 1.2 μSv, LLIF+PSP: 9.2 μSv, MI-TLIF: 102.3 μSv) experienced significantly lower exposures. Radiation exposure was not correlated with the patient's body mass index (p ≥ 0.233); however, it was positively correlated with increasing patient age (p ≤ 0.004). Real-time monitoring of radiation exposure is currently feasible and shortens the time between exposure and the availability of information regarding that exposure. A shortened feedback loop that offers more reliable and immediate data would conceivably raise the level of concern for radiation exposure in spinal surgeries and could alter patterns of behavior, leading to decreased exposures. Further studies are ongoing to determine the effect of real-time dosimetry in spinal surgery.

Overlapping Surgery Increases Operating Room Efficiency Without Adversely Affecting Outcomes in Total Hip and Knee Arthroplasty

BackgroundSeveral recent studies have demonstrated that overlapping surgeries in total hip (THA) and knee (TKA) arthroplasty do not increase the rates of complications, but whether this practice is cost-effective has yet to be addressed in the literature. The purpose of this study is to determine the effect of overlapping surgery on procedural costs and surgical productivity during THA and TKA. MethodsWe identified all patients undergoing primary THA or TKA from 2015 to 2018 by 18 surgeons at a single orthopedic specialty hospital. Procedural and personnel costs were calculated for each case using a time-driven activity-based costing algorithm. Overlap of surgical time by at least 30 minutes was used to define an overlapping procedure. We compared costs and outcomes between overlapping and nonoverlapping procedures, standardizing all costs to 8-hour time blocks. A multivariate regression analysis was performed to determine independent effect of overlapping procedures on costs and outcomes. ResultsOf the 4786 consecutive procedures, 968 (20.2%) overlapped by at least 30 minutes. Although overlapping rooms increased mean operative time by 8.3 minutes (P < .0001) and operating room personnel costs by $80 per case (<.0001), overlapping surgeons could perform significantly more procedures per 8 hours (7.6 vs 6.4; P < .0001), increasing total 8-hour profit margin by $1215 per procedure. There was no difference in 90-day readmission rate, length of stay, or rates of discharge home between the groups. ConclusionOverlapping noncritical portions of procedures in primary THA and TKA appear to be both a safe practice and an effective strategy.

Application of Electrosurgical Units by Operating Room Personnel: Development and Psychometric Testing of an Instrument

Background: Today, electrosurgical units are an indispensable part of surgeries. Yet, inappropriate application of this equipment can result in dire consequences for both the patient and the surgical team. Objectives: The present study aimed at developing the psychometric properties of a checklist to evaluate the application of electrosurgery units by operating room personnel. Methods: The present methodological study was performed in two stages: first, the items of the checklist were developed based on a literature review and search in relevant websites; and second, the psychometric properties of the checklist were measured using the methods to evaluate face, content, and construct validities. The reliability was measured through an assessment of the internal consistency of the checklist, based on the degree of inter-rater agreement. To assess construct validity, the researchers compared known groups; 40 surgeries were observed in two university hospitals in the intervention and control groups. Results: The content validity index (CVI) of all the items was over 0.79. The average CVI (S-CVI/Ave) of the checklist with 32 items was 0.97. The results of the Wilcoxon test showed that the posttest performance scores of the personnel in the intervention group were significantly higher than their pretest scores (P value = 0.005). The internal consistency (the Kuder-Richardson coefficient) of the checklist was 0.66. Conclusions: Due to the great importance of appropriate application of electrosurgery units, a reliable instrument is needed to assess personnel’s performance in this area. The results of the current study showed that the present instrument is sufficiently valid and reliable to evaluate the application of electrosurgical units by the operating room personnel.

All India difficult airway association (AIDAA) consensus guidelines for airway management in the operating room during the COVID-19 pandemic.

Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) which causes coronavirus disease (COVID-19) is a highly contagious virus. The closed environment of the operation room (OR) with aerosol generating airway management procedures increases the risk of transmission of infection among the anaesthesiologists and other OR personnel. Wearing complete, fluid impermeable personal protective equipment (PPE) for airway related procedures is recommended. Team preparation, clear methods of communication and appropriate donning and doffing of PPEs are essential to prevent spread of the infection. Optimal pre oxygenation, rapid sequence induction and video laryngoscope aided tracheal intubation (TI) are recommended. Supraglottic airways (SGA) and surgical cricothyroidotomy should be preferred for airway rescue. High flow nasal oxygen, face mask ventilation, nebulisation, small bore cannula cricothyroidotomy with jet ventilation should be avoided. Tracheal extubation should be conducted with the same levels of precaution as TI. The All India Difficult Airway Association (AIDAA) aims to provide consensus guidelines for safe airway management in the OR, while attempting to prevent transmission of infection to the OR personnel during the COVID-19 pandemic.

The effectiveness of an operating room etiquette video on medical student comfort in the gynecologic operating room

Background: Medical students spend a large portion of their obstetrics and gynecology (OB/GYN) rotation in the operating room (OR). We identified a deficit in appropriate OR orientation and created a 10-min video reviewing OR etiquette and fundamental skills. Our primary aim was to investigate the effect of this video on medical students' comfort and self-assessed performance in the gynecologic OR. Our secondary aim was to examine if OR personnel rated students' performance higher 8 months after video introduction. Materials and Methods: A prospective, cohort study of 71 3rd- and 4th-year medical students participating in the core OB/GYN clerkship at the University of Pittsburgh Medical Center (UPMC). All medical student participants watched the video once during their clerkship orientation and had continuous online access. Participants completed a pre- and posttest survey assessing their comfort with various OR tasks. After each OR day, participants completed a brief self-assessment of their OR performance. OR staff were surveyed on medical student performance before and after video implementation. Data were analyzed using descriptive statistics, the signed-rank test, and Fisher's exact test via SAS 9.4 (SAS Institute, Inc., Cary, NC, USA). Results: Most students reported improvement on the daily self-assessment. Students without prior surgical experience demonstrated greater improvement in comfort with most OR tasks. OR staff perception of medical students changed favorably after video implementation in several domains. Conclusions: A brief video detailing OR etiquette and fundamental skills is an easily implemented resource to clarify OR tasks that often produce unnecessary anxiety for students. Improved OR staff perception of medical student performance may help streamline OR functioning.

Anesthesia practice in Covid-19 era: Unprecedented problems call for extraordinary solutions.

Anesthesia practice in Covid-19 era: Unprecedented problems call for extraordinary solutions.

Hospital infection control and behaviour of operating room staff.

Surgical site infections (SSIs) are a frequent complication of surgical procedures and one of the most common forms of hospital acquired infection (HAI). National/international guidelines and recommendations have been issued for prevention. The objective of this study was to observe the behaviour of healthcare workers engaged in surgical procedures and hence assess compliance with SSI guidelines. An observational descriptive study was conducted at a University hospital in southern Italy. A specifically designed form was used to record the actions of the surgical team during randomly selected surgical operations. Observations comprised the use of surgical attire, the frequency of doors opening and the number of staff in the operating room. A total of 308 operating room personnel was observed during 402 surgical procedures: 127 surgeons (41%), 39 anaesthesiologists (13%), 62 nurses (20%) and 80 students in training (26%). 96% of the surgical team wore scrubs, 93% of health workers wore a mask and of these 78% wore it correctly in order to completely cover the nose, mouth and beard (when present), 99% wore a cap (only in 48% was the hair completely covered), 50% of the operators wore gloves, 95% wore shoes dedicated to the operating theater and 23% also wore shoe covers, 56% wore gowns, and 22% had eye protection. Furthermore, the average number of health personnel in the operating theater was 8, the doors remained closed in 261 (65%) surgical operations. As the results indicated a low adherence to international guidelines among the personnel, it is suggested that training courses should be provided to increase staff awareness on prevention and management of HAI.

Radiation Exposure of Patient and Operating Room Personnel by Fluoroscopy and Navigation during Spinal Surgery

Intraoperative radiography imaging is essential for accurate spinal implant placement. Hazards caused by ionizing radiation raised concern on personnel’s work life long exposure in the operating room (OR). To particularize a cumulative risk estimation of radiation of personnel and patient, depending on used methods (C-arm fluoroscopy, O-arm navigation) and patient characteristics during spinal surgery, detailed investigation of radiation exposure in a clinical setting is required. Lumbosacral dorsal spinal fusion was performed in 37 patients (19 navigated, 18 fluoroscopy) during this prospective study. Radiation exposure was measured on several body regions with thermoluminescent dosimeters on patient and OR personnel (surgeon, assistant, sterile nurse, radiology technologist). Comparison between patient characteristics and radiation exposure was included. The highest patients values were measured in the surgery field and gonads area during navigation (43.2 ± 19.4 mSv; fluoroscopy: 27.7 ± 31.3 mSv; p = 0.02), followed by the thoracic region during fluoroscopy (7.7 ± 14.8 mSv; navigation: 1.1 ± 1.0 mSv; p = 0.06), other measured regions can be considered marginal in comparison. Amongst OR personnel exposure of the surgeon was significant higher during fluoroscopy (right hand: 566 ± 560 µSv and thoracic region: 275 ± 147 µSv; followed by thyroid and forehead) compared to navigation (right finger: 49 ± 19 µSv; similar levels for all regions; p < 0.001 in all regions). When compared to the surgeon, other OR personnel had significantly lower radiation doses on all body regions using fluoroscopy, and similar dose during navigation. The highest eye’s lens region value was measured during fluoroscopy for the patient (185 ± 165 µSv; navigation: 205 ± 60 µSv; p = 0.57) and the surgeon (164 ± 74 µSv; navigation: 92 ± 41 µSv; p < 0.001). There was a significant correlation between patient BMI and radiation exposure to the surgery field during fluoroscopy. To our knowledge, these data present the first real life, detailed comparison of radiation exposure on OR personnel and patients between clinical use of navigation and fluoroscopy. Although patient’s radiation dose is approximately 3-fold during navigation compared to the fluoroscopy, we found that a spinal surgeon could perform up to 10-fold number of surgeries (10.000 versus 883) until maximum permissible annual effective radiation dose would be reached. Especially for a spinal surgeon, who is mainly exposed amongst OR personnel, radiation prevention and protection must remain a main issue.

The relation between physical space standards, equipment standards, safety, health care and general health issues concerning the operating room personnel in university/educational hospitals affiliated with Birjand university of medical sciences

Introduction: Occupational health and safety threats in hospitals and clinical centers are more serious due to physical and psychological factors. Therefore, this study was conducted to determine the relationship between physical space standards, equipment and safety and general health of operating room personnel in hospitals affiliated to Birjand University of Medical Sciences in 2015-2016. Methods: This descriptive-analytical study was performed in all operating rooms of Birjand University of Medical Sciences hospitals and their personnel (n = 88). Research tools included equipment standards checklist (32 questions), physical space (25 questions), health (23 questions), operating room safety (21 questions) and GHQ-28 questionnaire. Checklist validity was confirmed based on the content validity and reliability coefficient of 0.85. Data were analyzed using SPSS / 18 software, central indices and correlation tests Results: On average, 86.29% of operating room standards were observed in Birjand University of Medical Sciences hospitals. Equipment standards (89.62%) and physical space standards (82.71%) were the highest and the lowest, respectively. There was a direct and positive relationship between the general health of personnel and the different aspects of standards, meaning that the higher the standard, the higher the general health of the personnel. Only the relationship between general health of personnel and standards of physical space and equipment was statistically significant (p &lt;0.05). Conclusion: The present study show that the occupational environment of the operating room, especially the presence of standard and safe physical space and equipment could significantly correlate with general health. Therefore, it is essential for managers to maintain physical, safety, equipment and infection control standards.

A Review of Techniques, Time Demand, Radiation Exposure, and Outcomes of Skin-anchored Intraoperative 3D Navigation in Minimally Invasive Lumbar Spinal Surgery.

Retrospective cohort. To describe our technique for and evaluate the time demand, radiation exposure and outcomes of skin-anchored intraoperative three-dimensional navigation (ION) in minimally invasive (MIS) lumbar surgery, and to compare these parameters to 2D fluoroscopy for MI-TLIF. Limited visualization of anatomic landmarks and narrow access corridor in MIS procedures result in greater reliance on image guidance. Although two-dimensional fluoroscopy has historically been used, ION is gaining traction. Patients who underwent MIS lumbar microdiscectomy, laminectomy, or MI-TLIF using skin-anchored ION and MI-TLIF by the same surgeon using 2D fluoroscopy were selected. Operative variables, radiation exposure, and short-term outcomes of all procedures were summarized. Time-demand and radiation exposure of fluoroscopy and ION for MI-TLIF were compared. Of the 326 patients included, 232 were in the ION cohort (92 microdiscectomies, 65 laminectomies, and 75 MI-TLIFs) and 94 in the MI-TLIF using 2D fluoroscopy cohort. Time for ION setup and image acquisition was a median of 22 to 24 minutes. Total fluoroscopy time was a median of 10 seconds for microdiscectomy, 9 for laminectomy, and 26 for MI-TLIF. Radiation dose was a median of 15.2 mGy for microdiscectomy, 16.6 for laminectomy, and 44.6 for MI-TLIF, of this, 93%, 95%, and 37% for microdiscectomy, laminectomy, and MI-TLIF, respectively were for ION image acquisition, with the rest attributable to the procedure. There were no wrong-level surgeries. Compared with fluoroscopy, ION for MI-TLIF resulted in lower operative times (92 vs. 108 min, P < 0.0001), fluoroscopy time (26 vs. 144 s, P < 0.0001), and radiation dose (44.6 vs. 63.1 mGy, P = 0.002), with equivalent time-demand and length of stay. ION lowered the radiation dose by 29% for patients and 55% for operating room personnel. Skin-anchored ION does not increase time-demand compared with fluoroscopy, is feasible, safe and accurate, and results in low radiation exposure. 3.

Assignment of Medical Staff to Operating Rooms in Disaster Preparedness: A Novel Stochastic Approach

Following a large-scale disaster in a highly populated city, one can expect a large number of injured people to need urgent operation. If it can be assumed that the city in question is likely to experience a disaster (although the time of its occurrence is unknown), pre-disaster measures should be taken to mitigate the consequences of the disaster. This article aims to minimize the fatality rate through the proper assignment of operating room personnel to hospitals, such that both the expected value of the functioning operating rooms and the expected value of the service level are maximized. Service level is defined as a variable that has a negative relationship to the distance a patient is expected to travel in order to receive the required medical services. The probability of survival, for both personnel and operating rooms, depends on several stochastic factors. A biobjective mixed integer nonlinear model is proposed for the problem. A simulated annealing algorithm, particle swarm and a genetic algorithm are developed to solve the model using a weighted metric method. The model is applied to a possible worst-case earthquake scenario in Tehran. The results show that the proposed approach significantly improves the performance of post-disaster emergency relief.

A New Shielding Curtain for Protection of Intraoperative Radiation During Minimally Invasive Spine Surgery.

ObjectiveGradually increasing number of minimally invasive spine surgery (MISS), there is an increasing risk of radiation exposure to medical personnel during the surgery. We measured the radiation exposure of the operating room personnel during MISS, tried to find the riskiest person, and checked the effectiveness of a new lead-composite shielding curtain. MethodsRadiation exposure of medical staffs (operator, first assistant, anesthesiologist, and scrub nurse) involved in MISS procedures of 35 patients without shielding curtain (nonshield group) and 35 patients with shielding curtain (shield group). The shielding curtain had 0.25-mm nominal lead equivalent and was mounted on 2 frame bars fixed on the operating table. ResultsIn the nonshield group, radiation exposure was significantly higher in the order of operator > first assistant > scrub nurse > anesthesiologist (p < 0.001) during both anteroposterior (AP) and lateral views. In the shield group, the radiation exposure of the operator and the scrub nurse decreased significantly by 94.1% and 76.4% in AP view (p < 0.001), and by 96.3% and 73.9% in lateral view (p < 0.001), respectively. ConclusionSince the radiation dose of the operator was highest in a C-arm-guided MISS, there is a high priority need to protect the operator from the radiation exposure. The shielding curtain could most effectively reduce the radiation exposure of the operator.

Effective Factors on Occupational Burnout among the Operating Room Staff in Teaching Hospitals affiliated with Isfahan Medical University: A qualitative content analysis

Background: Burnout has negative effects on the performance of employees, especially on the operating room personnel, who are in contact with acute patients. The aim of this study was investigating effective factors on occupational burnout among the operating room staff at the teaching hospitals affiliated with Medical University of Isfahan, Iran. Methods: This study was a qualitative content analysis. The study had 20 participants selected from hospital managers, clinical supervisors, operating room supervisors, and hospital matrons in teaching hospitals (al-Zahra, Khorshid, Amin, Kashani, Feyz) of Isfahan in 2016.Participants were selected using the purposeful sampling method until information saturation was reached. Data were collected using a deep semi-structured interview, after thatall interviews were recorded and then transcribed and reviewed. Later, the data were analyzed by MAXQDA/12. Results: In this study, three main themes were achieved internal factors of organization, external factors of organization, as well as individual and personal factors of organization. Totally, these main themes had 51 subthemes. In the process of analyzing the main themes, we found that internal factors of organization had 37 subthemes, external factors of organization had 11 subthemes, and individual and personal factors of organization had three subthemes. Conclusion: Various factors related to job burnout were mentioned by decision makers. It is possible to resolve these factors by proper decisions of managers and heads of hospitals. Managers of hospitals should advance service quality, reduce costs, and decrease losses of burnout due to internal factors of organization, external factors of organization, as well as individual and personal factors of organization.

The utility of local smoke evacuation in reducing surgical smoke exposure in spine surgery: a prospective self-controlled study

BACKGROUND CONTEXTExposure to surgical smoke remains a potential occupational health concern to spine operating room personnel. Using a smoke evacuator (local exhaust ventilation) is currently regarded as a primary means of protection, yet few studies have evaluated its utility in actual surgeries. OBJECTIVETo examine the utility of two common types of local smoke evacuators, a para incisional evacuator and a smoke evacuation pencil, in reducing surgical smoke exposure in spine surgery. STUDY DESIGNA prospective self-controlled study. PATIENT SAMPLEAfter the pre-estimation of sample size, 51 consecutive spine surgeries (25 and 26 patients using the para incisional smoke evacuator and the smoke evacuation pencil, respectively) were enrolled between February 2018 and March 2019. OUTCOME MEASURESTwo outcome measures were used to evaluate the level of surgical smoke exposure, which was defined as the concentration of ultrafine smoke particles in the air (number of particles per cm3, ppc) around the operating table: (a) the average smoke level was the arithmetic mean of all measurements recorded during the surgery; and (b) the peak smoke level was the highest measurement recorded. METHODSConsecutive surgeries that involved bilateral symmetrical surgical exposure of the spine via a posterior midline incision were evaluated. Cauterized smoke was evacuated by two smoke evacuators: a “para incisional evacuator,” which used a flat broad suction pad positioned immediately adjacent to the incision (25 patients), and a “surgical smoke evacuation pencil” which is an incorporated part of the electrocautery (26 patients). The level of smoke exposure was measured separately when surgically exposing the two sides of the spine: starting with one side (determined randomly) with the smoke evacuator being turned on and, then, the other side with the smoke evacuator off. The results were compared between the two sides. RESULTSThe para incisional smoke evacuator significantly reduced the average smoke level by an average of 59.7% (287 [interquartile range {IQR}: 126, 526] vs. 1,177 [IQR: 395, 2,702], p<.001). The surgical smoke evacuation pencil also reduced the average smoke level by an average of 44.1% (917 [IQR: 448, 1936] vs. 1,605 [IQR: 775, 4,280], p<.001). Both evacuators significantly reduced peak smoke levels as well. CONCLUSIONSThis study provides evidence supporting the utility of local smoke evacuation in reducing surgical smoke exposure in spine surgery. Such technology may help to improve the occupational health protection for spine operating room workers.

The Use of Cementless Components Does Not Significantly Increase Procedural Costs in Total Knee Arthroplasty

BackgroundModern cementless total knee arthroplasty (TKA) designs have shown promising early clinical success; however, concerns exist regarding the higher cost of the cementless implants. The purpose of this study is to evaluate the total facility cost of cementless vs traditional cemented TKA along with the effect of cementless fixation on short-term outcomes. MethodsWe reviewed a consecutive series of patients between 2015 and 2017 who underwent either cementless or cemented primary TKA. Itemized facility costs were calculated for every procedure using a time-driven activity-based costing algorithm. Controlling for demographic variables and medical comorbidities, we performed a multivariate analysis to identify independent risk factors for facility costs following TKA. Short-term outcome metrics including complications, readmissions, and patient-reported outcomes were compared between groups. ResultsAmong the 2426 primary TKA patients in this study, 119 (4.91%) were performed using cementless implants. When compared to cemented TKA, cementless TKA patients had higher implant costs ($3047.80 vs $2808.73, P < .0001), but lower supply costs ($639.49 vs $815.57, P < .0001) and lower operating room personnel costs ($982.01 vs $1238.26, P < .0001). When controlling for confounding variables, cementless fixation did not have a significant effect on total facility cost or outcomes. ConclusionIn conclusion, the use of cementless TKA implants did not significantly increase total procedural costs when compared to traditional cemented TKA components at our institution. Our data suggest that the increased cost of a cementless implant is recouped through savings in cost of cement and supplies, as well as shorter operative times. The authors encourage investigators at other institutions to use the authors' methodology to evaluate (preferably in a prospective manner) whether the findings from this study can be corroborated.

Operating Room Personnel Determine Efficiency of Pediatric Spinal Fusions for Scoliosis

Study DesignRetrospective chart review. ObjectivesTo investigate the effect of different surgeons, anesthesiologists, and cRNAs individually and in teams on various perioperative and operative time intervals in a large, high-volume children's hospital. Summary of Background DataAlong with individual factors, studies have indicated that team factors play a role in efficiency, with larger teams leading to increased procedure times. An operating room (OR) staff dedicated to orthopedics has been reported to decrease turnover time; however, the characteristics and behaviors of surgical team members, to our knowledge, have not been analyzed as possible factors contributing to pediatric OR efficiency, and limited research has been conducted in the field of orthopedic personnel. MethodsChart review identified consecutive pediatric and adolescent patients who had primary posterior spinal fusion (PSF) of ≥7 levels for correction of spinal deformity. Time intervals and delays were recorded based on previous studies looking at OR efficiency and adjusted to the specific time points available in our perioperative nursing records. ResultsAdjusted for etiology, osteotomy, fusion levels, distance from hospital, staff switch, and body mass index, there was a significant difference in patient wait time among anesthesiologists, surgeon-anesthesiologist, and anesthesiologist-certified registered nurse anesthetist (cRNA) teams; in surgery prep time and total prep among surgeons and SA teams; and in surgery time and total room time among surgeons. There were no significant differences among cRNAs, individually, in any time interval. ConclusionsAnesthesiologists have a significant effect before and surgeons have a significant effect after entry into the OR. Identification of this variability provides an opportunity to study the differences in habits and processes of high- and low-efficiency teams, which can then be applied to all teams with the goal of improving performance of all surgical teams. Level of EvidenceLevel IV, case series.