Buddy operating in gynaecological oncology surgery: a large UK cancer centre's experience

Expert second opinions in surgery improve patient outcomes and influence surgical decision-making, allowing for peer review in peri-operative planning. The aim of this study is to assess the impact of “buddy operating” within gynaecological oncology on blood loss and length of stay (LOS) in hospital. A retrospective cohort study including all patients undergoing a hysterectomy (open and laparoscopic), for a gynaecological cancer, in 2004, 2014 and 2017. Data was collected using the hospital surgical ledger, Northern Ireland Electronic Care Record (NIECR) and online laboratory results. Data collected included the procedure performed, LOS, haemoglobin (Hb) levels pre- and post-operatively as a measure of blood loss, and number of consultants present. Only those for which insufficient data were available were excluded. Data was collected using Microsoft Excel and statistical analysis performed using JASPv0.16.1. The data followed a non-Gaussian distribution (Shapiro-Wilk p < 0.001). Analysis of Variance (ANOVA) was used to compare the frequency of procedures and overall Hb drop, The Wilcoxon-test was used to compare the mean Hb drop, and the Kruskal-Wallace test was used to compare the mean LOS. Statistical significance was defined as a p-value < 0.05. 630 patients were included. A 41.4% categorical reduction was shown in post-operative Hb drop between 2004 (22.7 g/L) and 2017 (13.3 g/L (p = 0.015)) for laparoscopic procedures following the implementation of buddy operating. There was no significant difference seen in the post-operative Hb drop for open procedures (p = 0.069). There was a 56% reduction in mean LOS from 2004 (12.1 days) to 2014 (6.1 days), which was significant for laparoscopic (p = 0.0025) and open procedures (p = 0.000033). In conlcusion, buddy operating is associated with a statistically significant reduction in blood loss for laparoscopic procedures and LOS for open and laparoscopic procedures.

Buddy operating; Laparoscopy; Laparotomy; Hysterectomy

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