When it comes to selecting surgical tables, versatility, durability, high weight capacity and C-arm compatibility are more important than price. This is the clear message of 153 responders to Outpatient Surgery's recent surgical table survey. Another point of agreement are the features many surgical facility managers feel they can do without, such as voice-activated controls and self-propulsion.
Here are the details.
Price is important, but...
Although 59 percent of our 153 responders rank price as a "very important" consideration when purchasing a surgical table, two-thirds or more rank versatility, high weight capacity, reputation for durability and ease of use with the C-arm as "very important" (see "Features You Can't Do Without" on page 64). "Price should not be the deciding factor," says Wayne Marler, a clinical specialist with South Alabama Outpatient Services in Enterprise, Ala. "Patient safety and user-friendly controls and features play a large part in deciding on the right table."
Other key features:
- Versatility. Eighty-five percent of responders rank versatility as "very important" because most use their tables for multiple procedures. In fact, 44 percent use their tables for procedures that cross every specialty. What makes a surgical table versatile? Features like radiolucency, easy-to-use attachments, sliding tops, adjustability and lots of articulation, report our responders.
"We can use our table for various procedures like urologic surgeries, laparoscopic cholecystectomies and pain management because it is fully radiolucent," says Tricia Camacho, the administrator for San Marcos Surgery Center (Texas). "We no longer have to worry about changing out tables for different procedures."
Adds Bob Harding, the director of surgical services for Mt. Diablo Medical Center in Concord, Calif.: "Versatility is greatly enhanced by components like cassettes, side extenders and leg attachments that are easier than ever to attach, position and store. These accessories are no longer an afterthought; they are integrated into the design of the table."
Mr. Harding also says the fact that his new table goes low to the ground helps his surgeons greatly. "Our shorter surgeons don't have to stand on lifts any more, which interfered with their movement and depth perception because of lighting differences," he says. "We can also lower the table for larger patients, and this eases strain on surgeons' shoulders because they don't have to reach up during surgery any more."
Adds Renea Goode, the director of nursing for the Surgery Center in Oxford, Ala., where surgeons perform dental, ENT, general, gynecologic, orthopedic, pediatric, plastic, podiatric and urologic surgeries: "The two features we had to have are the sliding top (which repositions the tabletop in relation to the pedestal for easier C-arm use) and a pop-off lower section, which allows our doctors to get their legs under the table during gynecologic procedures when patients are in stirrups. The airplane-like articulation is also great for easily tilting patients toward the head during gynecologic surgery or toward the side during gallbladder operations."
- High weight capacity. Two-thirds of responders rank this feature as "very important," and an additional 17 percent rank it as "somewhat important." Patients presenting for all types of surgeries, they say, are bigger and taller.
"We do not do bariatric surgery, yet more of our surgical patients, particularly shoulder patients, are very large and some are very tall," notes Mary Jane Patterson, the director of surgical services for Fisher Titus Medical Center in Norwalk, Ohio. Importantly, this doesn't mean simply picking a table with a high capacity rating. It also means choosing a table that can accommodate patients from side-to-side and that remains stable even when the patient position causes the center of gravity to shift away from the middle of the table.
"Some of our patients are as short as 4 feet, 8 inches tall yet weigh 250 pounds and, although they're well within the weight limit of our table, they have little to no side-to-side support," explains Ms. Patterson, noting she would like to add about five inches to either side of her approximately 20-inch-wide table. "We also had problems with instability when positioning cystoscopy patients even though their weight was well under the table's 450-pound capacity."
Ms. Patterson says it's important to be aware that some capacity ratings are based on supine positioning only. Adds Pensacola, Fla.-based Baptist Medical Park Surgery Center director Helen Sprowls: "With the growing population of overweight/obese patients, we feel uncomfortable putting our regular 300-pound weight limit tables to the test, especially with large persons undergoing knee arthroscopies. When we drop the foot of the table, it can become unbalanced."
- Reputation for durability. Eighty percent of responders also rated durability as "very important." "This is a big, long-term investment. You're not going to turn around and replace surgical tables in three years," noted Diana Procuniar, RN, BA, CNOR, the nurse administrator for Winter Haven Ambulatory Surgical Center (Fla.).
More than 32 percent of responders who purchased a table in the past two years say they opted for features they now feel are unnecessary, many of whom say they over-bought on more than one feature (See "Features You Bought But Now Consider Unnecessary"). The majority of these 35 responders (69 percent) point to their voice-activated controls as unnecessary. Nearly 50 percent say they also purchased unnecessary accessories, and 40 percent say they found they don't need their tables' self-propulsion feature. Says Ms. Procuniar: "You can easily over-buy attachments and other add-ons you may not need. You need to rely a great deal on your sales rep and physicians, but you also need to expand your own knowledge base."
The best way to avoid over-buying while ensuring that you get the features you need, agree our responders, is to do your homework and demo prospective tables. "Evaluating several vendors and knowing the differences in weight limits, articulation and accessories was a valuable lesson. Being able to demo the table allowed us to make the best purchase for our facility, rather than guess what we thought we would want," says Jennifer L. Misajet, the director of surgical services for North Colorado Medical Center in Greeley, Colo.
Several responders point out the importance of not only using the table many times, but doing so in the presence of the sales rep. Otherwise, they warn, ease of use can take precedence over versatility, and you might be sorry later. A more versatile table can sometimes take a little longer to get used to, they say, but once the staff understands how to use it, it often becomes the table of choice.
"I wish I had prodded the sales rep from a competing company to be in the room more with the staff ' I feel we bought a table with less flexibility because the staff felt the more versatile table was harder to use," says Lynn Lillie, the director of surgical services at Fort Madison Community Hospital (Iowa). "The truth is, I had worked with this brand of tables in another facility, where we had a good rep who made sure each of us knew how to use the table."
Patty Sebald, the director of surgical services at Saint Louise Regional Hospital in Gilroy, Calif., agrees: "I feel it is always important to evaluate any capital purchase. This evaluation period should be long enough to allow all surgeons and staff the opportunity to use the table a reasonable number of times to allow them to feel competent. This will enable the staff and surgeons to make a more educated decision before purchase."
Getting it right
When we asked responders who recently bought surgical tables what additional features they'd choose if they had a do-over, they confirmed the importance of versatility and high weight capacity. (See Features You Didn't Choose But Wish You Had.) Of the 46 responders who say they'd make a change, a full 41 percent say they'd choose a table with higher weight capacity, and 24 percent say they'd choose a table with improved C-arm compatibility.
Still, most of these responders expressed high overall satisfaction with their table purchases, in part because modern surgical tables are so much more versatile and user-friendly than the outdated models they typically replace. The simple fact that most modern tables are electric can make a world of difference to the OR staff.
"Our new tables replaced old tables that were nonelectric. Being able to articulate them without being on our hands and knees is a godsend," says Ms. Lillie. Adds Judy Wurstner, the director of Saint Francis Hospital in Memphis, Tenn.: "In the past, non-electric surgical tables were purchased to get more for the money ' but this was very short-sighted given the complex needs of patients today. I am currently replacing them with electric tables. This mobility is not only needed for surgical positioning, but it is a back-saver for the staff."
In all, nearly 93 percent of responders who bought a surgical table in the past two years say they are "satisfied" or "very satisfied" with their purchases. "I like the versatility of the table," concludes one happy responder. "There is not anything I dislike about it."