Methodology for the Audiovisual Analysis of Surgical Team Performance in Orthopedic Ankle Surgery

Abstract

Category: Basic Sciences/Biologics Introduction/Purpose: Defining and quantitatively measuring surgeon and operating room team performance remains a scientific and clinical challenge. Evidence-based, objective methods to assess surgical skill have been identified; however, a quantifiable and valid methodology to measure intraoperative performance is lacking. We aimed to determine the optimal approach to audiovisually assess a surgeon and a surgical team. We aimed to develop a high-fidelity method to analyze and improve surgeon and team performance. Methods: Funding of this study was provided through a grant awarded by the American Orthopaedic Foot and Ankle Society (#2015-24-P). Sixteen predetermined, bilateral ankle surgeries (frame placement, frame removal, and total ankle replacement) were performed between July and December 2015 in both live and simulated operating room settings. Still photography and web- based three-dimensional modeling software were used to determine optimum camera position for the first eight procedures. Three compact, high-resolution camcorders (GoPro® Hero, San Mateo, CA) were then employed in different locations with a variety of mounting strategies to record eight additional, matched ankle procedures in a simulated environment. A multiview box and wireless routers were used for live viewing of surgeries on a high-definition television screen. Video-based editing software was used to replay and analyze audiovisual output. Results: There are several visual angles that optimally capture the dynamics of a surgical team and are specific to surgery type. These angles are measurable (in degrees) and vary according to the position of the surgeon, team members, operating room table, and C-arm, as well as laterality of the procedure itself. Triangulated placement of multiple cameras, including a head mounted device, are required to assess subtle elements of operating room team performance, including individual strengths and weaknesses, nontechnical skills, and team dynamics. High-fidelity recording equipment and video-based editing software facilitate the assessment of characteristics unique to reconstructive ankle surgery. Conclusion: The effectiveness of a surgical team can be assessed with high-fidelity recording and editing equipment in defined configurations. Our approach, which to our knowledge has not been previously described, facilitates the evaluation of communication styles, technical skills, and teamwork and provides a foundation for intraoperative leadership. We propose that our audiovisual methodology can be used to coach surgeons and their teams, in order to make collaborative improvements in a non-punitive manner. Enhancing the performance of each member of the surgical team may reduce risk and ultimately improve patient outcomes, and is likely to be reproducible across disciplines.