Disruptions love company: Investigating flow disruption clusters in robotic surgery

摘要

Assessment of the safety and efficiency of new technologies in the operating room (OR) is critical, as an increasing number of technologies are adopted every year. An effective metric in system performance in the OR is the measurement of flow disruptions (FDs), defined as any deviation from the natural progression of a surgery. This current study concerns the prevalence of the FD cluster; defined as the occurrence of at least five successive FDs in a given period of time (1-10 minutes), across 89 robotic surgeries. The analysis examined 1) the extent of five FDs occurring in a given period of time (1-10 minute interval), 2) whether FDs are more likely to occur in a cluster than in isolation, 3) the Cluster Rate per case (cluster events per case/ surgery duration), 4) whether contextual factors (e.g., surgeon experience) share a relationship with the cluster event, 5) the relationship between FDs in clusters, 6) if particular FDs occur in clusters more than others, 7) whether certain types of FDs are more likely to lead to a cluster event. Clusters were found in 38/89 of the cases examined establishing their existence and regularity in robotic surgery. A clusters structure is generally composed of the most frequently observed flow disruptions in that particular case. The rate at which clusters occurred across surgeries could be partially explained by Communication, Training, and Patient Factor FDs. The current study expands the understanding of systematic FD clustering and provides a framework for future research on this topic.