• Ahmed M Raslan, Jeffrey Steven Raskin, and Jesse Jia-Xin Liu.
• Neurosurgery. 2015 Aug 1;62 Suppl 1:214.

IntroductionQuality improvement projects have begun to standardize surgical work flow as a component to optimize operative room (OR) efficiency. Removing special cause variability resulting from nonsurgical waste is an obvious target; however, surgical resident education must be maintained even in the setting of process improvement. There are no published data describing the impact on operative time of resident-identified risky or uncomfortable procedural steps during posterior instrumented fusion (PIF). Self-identification of risk or discomfort in surgical steps may allow for shorter OR time and reduced cost, without sacrificing resident education.MethodsPIF procedure steps were defined. An 8 two-part question survey regarding surgeon comfort level and perceived risk assessment at each step was developed, and completed by junior (17) and senior residents (10), and faculty (6) from orthopedic and neurological surgeons. A risk matrix was constructed defining 2 zones, a "danger zone" where responses were both high risk (3-5) and low comfort (1-3) and a "safe zone" where responses were low risk (1-2) and high comfort (4-5). One-tailed χ with Yates correction was performed.ResultsRisk matrix analysis showed a statistical difference among danger zone respondents between junior resident and faculty groups for exposure, pedicle screw placement, neural decompression, interbody placement, posterolateral fusion, and hemostasis (Table 2). Radar graph identifies percentage of respondents who fall within the danger zone (Figure 1).ConclusionResident perception of surgical complexity can be evaluated for procedural steps using a risk matrix survey. For PIF, residents assign more risk and are less comfortable performing steps in a training-dependent manner. Identification of particular high-risk steps, which are uncomfortable, should prompt strict faculty oversight to improve patient safety, monitor resident education, and reduce operative time.

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