Patient Safety in Surgery最新文献

Robotic surgery has expanded minimally invasive options but introduces specific vulnerabilities during intraoperative emergencies. The physical separation of the surgeon from the patient, restricted access due to docking, and dependence on complex technology can delay life‑saving interventions if teams are not prepared. This review summarizes current evidence and expert practice on emergency management along the perioperative pathway in robotic surgery, focusing on a structured, systems‑based salvage strategy. Key domains include preoperative planning, classification of recoverable and non‑recoverable errors, and standardized protocols for rapid undocking, conversion, hemorrhage control, and resuscitation. Particular emphasis is placed on human factors, including visible name tags, closed‑loop communication, and structured briefings to strengthen situational awareness and role clarity in crises. Simulation‑based curricula and high‑fidelity in situ drills are highlighted as essential for rehearsing rare but high‑impact events such as catastrophic bleeding, cardiorespiratory collapse, or robotic system failure. In parallel, technology‑driven tools such as surgeon‑controlled suction, advanced vessel sealing, and artificial‑intelligence-assisted monitoring are discussed as adjuncts for earlier recognition and standardized documentation of critical events. Integrating these elements into protocolized workflows can improve preparedness, shorten response times, and support safer decision‑making when seconds matter in robotic surgery.

Background: Inappropriate health care reduces the quality of care and efficiency of the health system. The goal of this study was to analyze the frequency of overuse of five surgical procedures while also determining the epidemiological characteristics of both patients and interventions.

Methods: This is a retrospective observational cohort study performed in a tertiary referral center in Spain. Surgical Overuse was analyzed according to five "Choosing Wisely" recommendations related to both interventions and perioperative care. The association between overuse and the characteristics of patients and procedures was assessed by bivariate and multivariate predictive analysis. Costs were calculated for each clinical episode using data from the hospital's accounting department; total hospitalization costs from the index procedure to hospital discharge were used for intervention-related overuse, and average unit cost for perioperative practices.

Results: A total of 895 clinical episodes were analyzed over one year. Low-value surgery was identified in 9.7% (N: 87; 95% CI: 7.9 to 11.9). Specifically, overuse was identified in 59.6% (53 out of 89; 48.6 to 69.7)) of the echocardiograms performed after valve replacement, 15.7% (26 out of 166; 10.6 to 22.3) of podiatric surgeries, and 2.0% (8 out of 400; 0.9 to 4.1) of cholecystectomies for asymptomatic cholelithiasis. No overuse was found among Mohs surgeries or in the perioperative use of opioids for pediatric patients. The risk of overuse was higher in patients with the following characteristics: increased age (OR [95% CI]: 1.1 [1.1 to 1.2] for each additional year); ≥1 intrinsic risk factor (IRF) (3.5 [1.5 to 8.0] versus absence of IRF); and hospitalized patients (12.8 [4.5 to 37.1] versus ambulatory surgery). Overuse represented an overall cost of €86,858.05.

Conclusion: Applying five "Choosing Wisely" recommendations, low-value surgical practices were identified, mainly involving echocardiograms after valve replacement, podiatric surgery, and cholecystectomies. Such practices were more frequent among older and hospitalized patients and were associated with direct economic costs.

Background: Patient safety in operating rooms has globally improved through interventions such as the World Health Organization (WHO) Surgical Safety Checklist and multidisciplinary team training. However, while evidence from high-income countries is well documented, there remains limited consolidated knowledge on the understanding, application, and effectiveness of safety culture interventions in African surgical settings, which this review seeks to address.

Methods: This systematic review examined factors and protocols affecting surgical safety in African operating rooms. We hypothesized that persistent systemic barriers undermine safety culture despite adoption of global measures. Following PRISMA 2020, we searched eight databases (Medline, Embase, Cochrane, Africa-Wide, CINAHL, Global Health, Global Index Medicus, Web of Science) from inception to 5 December 2024, using variations of text words present in the title, abstract, or keyword fields, alongside relevant subject headings, to identify articles addressing surgical safety and culture throughout Africa. Included studies involved operating room professionals in African countries and used quantitative, qualitative, or mixed-methods designs. We excluded non-operating room settings, patient-only studies, inaccessible full texts, reviews, editorials, letters, conference abstracts, and duplicates. Two reviewers independently screened and appraised studies using the Mixed Methods Appraisal Tool. Findings were synthesized narratively with subgroup analysis by study type and theme.

Results: Out of 9,875 identified records, 22 studies from 12 African countries (2014-2024) met inclusion criteria, with Ethiopia contributing the highest number (n = 4). Various assessment tools, including the Hospital Survey on Patient Safety Culture, the Safety Attitudes Questionnaire, and the National Surgical, Obstetric, and Anaesthesia Plans interview manual, revealed recurring challenges: inadequate non-punitive responses to errors, communication barriers, hierarchical structures, and resource constraints. Four interventions showed promise: implementation and training on the WHO Surgical Safety Checklist, Safe Surgery 2020 initiatives, Non-Technical Skills for Surgeons training, and multidisciplinary training.

Conclusion: The heterogeneity of study designs, sample sizes, and outcome measures limited direct comparisons and precluded meta-analysis. Nonetheless, the review highlights persistent barriers and emerging opportunities to strengthen patient safety culture in African operating rooms. While the WHO Surgical Safety Checklist remains valuable, sustainable progress requires multi-level strategies that address systemic constraints and incorporate context-sensitive adaptations.

Registration: PROSPERO, CRD42024627076.