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 3 h in duration.

Methods

Prospectively collected databases from two institutions were retrospectively queried to identify all orthopaedic procedures of maximum mean duration of 180 min 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 3 h in duration. This highlights the importance of developing strategies to prevent intraoperative scrub nurse turnover to improve OR efficiency and decrease healthcare costs.