Patient Safety in Surgery最新文献

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.

Background: Bile duct injuries following laparoscopic cholecystectomy are rare but serious complications. Timely diagnosis and optimal management remain challenging. Classification systems for bile duct injuries may facilitate diagnosis, guide treatment, and improve outcomes, however their clinical use is limited. This study systematically evaluated existing classification systems and assessed their applicability to all types of injuries. Based on this analysis, a new classification system for acute lesions was developed.

Methods: The database of the German Arbitration Board for medical liability issues was queried to identify cases involving bile duct injuries following a cholecystectomy (1990-2021). For each patient, the anatomical location, extent of injury, and therapeutic approach were documented. Injuries were categorized according to 11 published classification systems and a newly developed classification system. The ability to categorize bile duct injuries of all systems was assessed.

Results: A total of 106 bile duct injuries were identified. The common bile duct was the most frequently injured structure (31.1%), followed by combined injuries (27.4%), and injuries of the common hepatic duct (17.9%). In 13.2% of cases, an artery was injured in addition to the bile duct lesion. Only 30.2% of bile duct injuries were detected intraoperatively. The most frequently performed techniques were biliodigestive anastomosis (34.4%), direct bile duct anastomosis (31.3%), and leakage closure with stitches (28.1%). None of the 11 existing classifications could categorize all cases; the best-performing systems (Amsterdam, Hannover) classified 82-86%. In contrast, the new Brandenburg Acute Bile Duct Injury (BABD) Classification was able to categorize 99% of the injuries.

Discussion: Current classification systems fail to categorize all acute bile duct injuries following cholecystectomies. The BABD Classification, which is based on the anatomical location and extent of injury, allows systematic categorization of all documented acute bile duct lesions and may improve diagnostic clarity, treatment planning, and comparability in future studies.

Background: In low-resource countries, the incidence of lower extremity long-bone fractures exceeds that in high-resource countries due to higher rates of motor vehicle collisions (MVCs). This situation is worsened by limited resources for adequate care, resulting in significant health and economic impacts. Locked intramedullary nailing (IMN) is a widely accepted treatment for lower extremity fractures, but it carries risks of complications, which have not been well-studied in low-resource settings. Considering the resource differences between high- and low-resource settings, local research is essential for identifying modifiable factors to prevent complications. This study investigated the predictors of complications after IMN with "Surgical Implant Generation Network" (SIGN) nails (Richland, WA, USA) for lower extremity fractures in a low-resource setting.

Methods: A secondary analysis was performed on prospectively collected data from 666 fractures in 603 patients treated with SIGN nails at a mission teaching hospital in southwestern Nigeria between July 2014 and June 2024. The mean age was 43.2 years, and 65.7% of the patients were male. Fractures meeting the inclusion criteria were classified as with or without complications. Two-thirds (66.8%) were femur fractures, and 33. 2% were tibia fractures. Univariate and binary logistic regression analyses identified significant predictors of complications.

Results: The overall complication rate was 11.7%, with infection and non- union being the most common. The mortality rate was 1.1%. Independent predictors of complications included injury mechanism (p = 0.033), fracture age (p = 0.003), fracture type (p < 0.001), prior treatment elsewhere (p = 0.007), and surgery duration (p = 0.004). Fractures resulting from MVCs, older fractures, and open fractures showed higher complication rates. Each additional 30 min of surgery increased the odds of complications by 34% (95% CI, 1.003-1.017).

Conclusion: This study shows that IMN with SIGN nails is an effective treatment for fractures in low-resource settings. However, challenges remain, especially with open fractures and delayed treatment. Prioritizing timely surgery, improving infection control, and enhancing surgical efficiency are essential for better outcomes. The findings inform strategies for improvement and highlight the need for further research to develop evidence-based guidelines for IMN in low-resource environments.

Background: Re-exploratory laparotomy in obstetrics and gynecology is a serious and challenging surgical event associated with significant morbidity and mortality. Understanding its incidence, indications, and outcomes is crucial for improving patient care and surgical safety. This study presents a comprehensive analysis of re-exploratory laparotomies over a 10-year period in a major tertiary care center.

Methods: A retrospective cohort study was conducted on all patients who underwent re-exploratory laparotomy following obstetric or gynecological surgery between 2014 and 2024. Data on patient demographics, primary surgery, indications for re-exploration, time to re-intervention, procedures performed, and postoperative outcomes were collected and analyzed. Statistical analysis was performed using descriptive statistics, chi-square tests, and t-tests to identify significant associations.

Results: A total of 117 cases of re-exploratory laparotomy were identified. The mean age of patients was 31.8 ± 7.0 years. The most common primary surgeries were Cesarean Sect. (46.2%) and total abdominal hysterectomy (23.1%). The leading indications for re-exploration were postpartum hemorrhage (26.5%), muscle hematoma (20.5%), and burst abdomen (17.1%). The mean time to re-exploration was 4.7 ± 2.7 days. The overall mortality rate was 8.5%, and the postoperative complication rate was 46.2%. No significant association was found between the level of emergency and patient outcome (p = 0.637).

Conclusion: Re-exploratory laparotomy remains a critical event in obstetric and gynecological practice, with hemorrhage and postoperative wound complications being the primary drivers. This study highlights the need for meticulous surgical technique, early recognition of complications, and prompt intervention to improve patient outcomes. Further research is needed to identify high-risk patient groups and optimize management strategies.

Background: Surgical safety checklists are essential for reducing errors and improving outcomes, but consistent, full-phase adherence remains suboptimal. Traditional paper-based systems can disrupt workflow and limit team engagement. Voice-enabled solutions offer potential to improve compliance while preserving sterile conditions and communication flow in the operating room (OR).

Methods: This study aimed to develop and evaluate a prototype voice-controlled digital assistant for surgical checklists - referred to as 'VoiceCheck' - with a focus on usability, technical performance, and feasibility in real-world clinical settings. VoiceCheck guides clinical teams through the "Sign In", "Time-out", and "Sign Out" phases of the surgical checklist using voice commands and speech transcription. The system operates offline, incorporating Rhasspy for intent recognition and Whisper for speech-to-text transcription. Twelve surgical team members participated in a field evaluation, completing structured tasks alongside routine workflows. Usability was assessed using the System Usability Scale (SUS) and a custom questionnaire. Technical evaluations tested Whisper V2 and V3 under quiet and noisy conditions, and Rhasspy's intent and wake word recognition across 1'125 commands in two environments (noisy, quiet).

Results: Participants rated usability positively (SUS median score 76.04). Whisper V3 achieved 90.7-97.3% transcription accuracy, outperforming V2 in noisy settings. Rhasspy recognized intents with 92.8-94.8% accuracy and maintained a low false-positive rate. VoiceCheck functioned reliably offline and was preferred with a conference microphone for multi-user interaction.

Conclusion: VoiceCheck demonstrates feasibility for voice-assisted checklist execution in surgical settings. It was well accepted by users and performed reliably under realistic conditions. Further research should explore clinical integration, workflow impact, and multilingual capabilities.