Stick to the basics: Unless you are a single specialty center and know you will stay that way, steer away from buying highly specialized tables, experts say. Instead, think about buying solid general-purpose surgery tables and accessorizing them. Such tables will serve you well for all sorts of cases, and with regular maintenance, last for years.

Go electric, if you can. Most OR personnel agree that although electric tables may be more expensive, they make patient positioning much easier and may be well worth the extra cost. At the HealthSouth Exeter Surgery Center in Reading, Pa., the staff finds electric tables to be particularly useful for breast augmentation cases. "After the implants are in, we normally incline the patient on the table to check on the aesthetic appearance of the breasts. This would be extremely difficult with a manual table," says Cindy Stanson, Director of Nursing. Andrea Blanchett, RN Manager at Trinity Outpatient Surgery Center in New Port Richey, Fla., agrees. "Electric tables are usually very easy to operate - they don't require two hands. This is extremely useful, especially when you don't have extra staff."

If you do go electric, make sure you have a battery backup, says Bobbi McMinn, an OR manager at the Bothwell Regional Health Center in Sedalia, Mo. Many tables will go automatically to battery backup in the event of a power failure. If possible, get a table that allows you to detach the electric cord from the bed, so you can remove it completely when you move the table, says Ms. Blanchett. Otherwise, the cord may get caught in the wheels. Two other features that may be useful are a backup control unit (some tables have the backup remote control in the base column) in case the main control malfunctions, and a manual foot pump to provide a second source of auxiliary power to drive the hydraulics of the table.

If your budget doesn't allow for electric tables (they can be $3,000 to $4,000 more than the manual variety), look for tables with easy-to-use controls, says Ms. Stanson. She recommends that you study and know exactly how the mechanics work before you make your final decision.

Table Accessories

If your center hosts many shoulder procedures, consider the Shoulder Chair, from OR Direct. This accessory attaches to Amsco (Models 1080, 2080, and 3080), Skytron (3500, 6001, and 6500), and Getinge/Castle (4900 and 5100) tables to keep the patient upright and provide unhindered access to either shoulder. A padded U-shaped head restraint holds the head secure; the headrest removes easily for anesthesiologist access. OR Direct's Yellofin Stirrup may make your laparoscopy procedures, and any other cases requiring low lithotomy, dual site exposure, or intraoperative repositioning, much easier. The stirrups completely encapsulate the patient's feet and prevent excessive pressure on the calf, for maximum patient comfort. They also have a proprietary "Lift Assist" mechanism that neutralizes the leg weight, allowing staff to easily move the legs to any desired position. Call (800) 673-4732 or visit www.ordirect.com. If you do a lot of hand and wrist surgeries or lower extremity cases, you may want to look into the Ultra-Light Specialty Table or the Universal "K" Table, both from Instrument Specialists, Inc. These accessories may provide a wider, more stable base than traditional armboards. Both tables are radiolucent platforms that attach to the side rails of your OR table with mounting clamps; if needed, you can rest them on a telescoping leg for extra support. The tables allow the extremity to be supported away from the body, allowing easier C-arm access. Both tables are lightweight and portable - the Ultra-Light is nine pounds and the Universal "K" is 16 pounds. You can use the latter for head/neck, lower extremity, and even pediatric procedures, according to the company. It also comes with a traction package that can be used with a traction apparatus or IV pole. Call (800) 537-1945 or visit www.isisurgery.com.

Watch your weight: Most tables will be able to support at least 400 lbs. However, "check that the table can support the weight in not just the flat position, but also in articulated positions, such as Trendelenberg and reverse Trendelenberg," advises Ms. McMinn. Also make sure that it can support the weight of the patient plus any accessories.

"As the patient population becomes heavier, it's useful to have at least one table that can support extra weight," says Susan Musser, OR Manager at the HealthSouth Surgery Center of Lancaster in Lancaster, Pa. It may not be a bad idea to have at least one table that can handle more than 400 lbs.

Check for imaging compatibility: Using fluoroscopy during surgery has become increasingly important in minimally invasive surgery, and sometimes, the surgeon may also want to take a conventional X-ray. To ensure that a table is compatible with C-arms and X-ray machines, check for three things:

1. Full radiolucency: Many tables have carbon-fiber tabletops, which allow you to shoot an image anywhere along the length of the table. If you use fluoroscopy frequently, you may want to purchase a table with a wider top (most are about 20 inches across) to allow for a greater imaging area.

2. A tunnel or raised tabletop to place an X-ray cassette: A tunnel is a built-in channel that runs under the length of the tabletop. Tables with raised tabletops provide a separate surface underneath where you place the cassette. With a tunnel, you can only load the cassette from the head or the foot, whereas with the raised tabletop, you can load the cassette from the head, foot, or either side for a wider range of exposure angles. Raised tabletops force you to clean two surfaces, though, whereas tunnels don't.

3. Positioning options: Positioning a C-arm around a surgical table can be tricky, since the base of the table tends to get in the way. To get around this problem, manufacturers have come up with three solutions:
- On the most basic electric tables, you may have to position the patient opposite of the way you would normally do in order to circumvent the table pedestal and get the C-arm where you need it to be. This forces you to "think backwards" to position the patient vertically - in other words, the "back up" becomes "leg up." If you buy a table like this, look for an "orient patient" feature on the controls that automatically translates the functions for you.
- More advanced tables may have a "top rotation" feature that allows you to rotate the tabletops 180 degrees on their pedestals without repositioning the patient.
- The most advanced models have a longitudinal slide feature that allows the tables to move from end to end on their pedestals. This feature offers maximum C-arm access with minimum patient and table movement.

Skytron's OP1900 Outpatient Surgical Table features a radiolucent tabletop with an X-ray cassette tunnel.

4. Watch out for hidden "gotchas": "We once purchased a ‘split-leg' table, which had a removable bottom section that came with the table," says Ms. McMinn. "However, to use that bottom piece, we had to purchase a connection piece, which the manufacturer charged separately for. Without it, the table would have been unusable." The moral of the story is to understand exactly how the table works and what pieces you need before you make your final decision. Know how the accessories fit on the table, how they work with the table controls, and how they affect changes in patient positioning. This is especially true if you plan to accessorize a general surgical table to handle specific procedures. Otherwise, your price comparison will be inaccurate.

5. Take transportation into account: "Normally, our tables stay in one place, but we sometimes move our specialty tables from room to room," says Ms. McMinn. She looks for tables that are simple to maneuver, with large casters, to make this task easy. If your tables are constantly on the move as well, you may want to consider tables that have built-in self-propulsion systems to make transport easier for your staff.

Prepare for patient comfort: Most tables will support and cushion patients on pads that are at least two inches thick. For longer cases and frail patients, some centers keep a supply of gel-foam pads to place under elbows, knees, and bony prominences. Some stick with more basic tools. "Pads are nice, but they can be difficult to clean," says Chris D'Orio, RN, a manager at the Surgery Center of Salem County in Salem, NJ. "We use towels and blankets for padding - they work just as well and can be laundered more easily."

Consider a "gently-worn" model: Buying a pre-owned or refurbished table may be a great way to keep costs down, but it may require some added vigilance to make sure you are getting a reliable piece of equipment that will serve your needs. Two tips:
- Always contact the original equipment manufacturer of the table to make sure the company supports the device with accessories, parts, and service, advises John Dieterich, director of marketing at Steris Corp, an Ohio-based medical equipment maker. The OEM may also be able to steer you to a reputable refurbisher.
- Realize that there are no government or industry standards for refurbishing tables, says Mr. Dieterich. Some companies may simply clean the tables before reselling them, while others may replace and recondition almost all the critical parts. He recommends that you ask for a detailed description of what the refurbisher does to all its tables, as well as a full disclosure on the service history of the particular table you're considering.

6. Ask around: Whether you are purchasing a new or used table, find out what other facilities have experienced with the model and maker you are considering. "When we purchase a table, I always check with one of my sister facilities," says Bonita Koller, a purchasing manager at the HealthSouth Exeter Surgery Center in Reading, Pa. "The maintenance manual and salespeople will only tell you so much. Users of the table will be willing to tell you about any bugs that had to be worked out or if they didn't care for some features."