Patient Safety in Surgery最新文献

Background: Postoperative delirium is a frequent complication following surgery in elderly patients. Despite its strong association with poor health outcomes the literature in Nigeria has been limited to a few case-reports. A major barrier to improving delirium care in elderly individuals is its poor detection, particularly in surgical populations. We aimed to determine the incidence, detection rate and risk factors for postoperative delirium in our cohort of elderly surgical patients.

Methods: We conducted a prospective cohort study in a regional orthopedic and plastic surgical center in Enugu, Southeast Nigeria, between April 2020 and March 2024. The participants were patients aged 65 years and above, who underwent surgical procedures. Each patient was visited daily by a trained nonpsychiatrist physician during the first three days after surgery and was assessed for delirium during each visit. The "Confusion Assessment Method" algorithm was used for the diagnosis of delirium. The motor subtypes were classified on the basis of the predominant psychomotor disturbance (hyperactive, hypoactive, mixed, or none). Multivariate analysis via binary logistic regression was used to determine the predictors of delirium. The level of statistical significance was determined by a p value of < 0.05.

Results: Data from 304 patients (mean age, 71.7 ± 6.4 years) were analyzed. The incidence of postoperative delirium was 24.0% (73/304). The delirium subtype manifestations were "hypoactive" 35.6%, "hyperactive" 35.6%, "mixed" 20.5%, and "none" 8.2%. Approximately 92% (67/73) of the delirious cases presented within 48 h following surgery. Among the delirious cases, 90.4% (66/73) were undetected by the managing surgical teams and nursing personnel. The predictors of delirium were perioperative anaemia (AOR = 4.6; 95% CI: 1.3-16.5), impaired preoperative cognitive status; (AOR = 4.5; 95% CI: 2.0-9.9), perioperative blood transfusion (AOR = 2.1; 95% CI: 1.1-4.2), and surgery lasting between 120 and 179 min (AOR = 0.3; 95% CI: 0.1-0.8).

Conclusion: Postoperative delirium was grossly underrecognized by the managing surgical teams and nursing personnel. Education of the healthcare providers, with implementation of routine monitoring for postoperative delirium using validated tools is recommended. Perioperative anaemia and blood transfusion were modifiable risk factors for postoperative delirium in these patients, and improvements in patient blood management offer great potential for safer care.

Background: Despite the critical role of central airway dimensions in clinical practice, comprehensive normative data remain scarce globally, particularly for diverse ethnic populations. This study aims to establish the first high-resolution computed tomography (HRCT) based reference values for tracheobronchial anatomy in Indian adults, addressing a significant gap in precision medicine.

Methods: This retrospective cross-sectional study was conducted at Kasturba Hospital, Manipal, India. HRCT chest scans performed between January 1, 2021, and March 31, 2024, were screened, and 503 adults (277 males, 226 females; aged 20-80 years) with normal findings were included. Primary outcomes were normative tracheal and bronchial dimensions (lengths, diameters, cross-sectional areas). Secondary outcomes included age and gender-based variations, correlations with demographics, and predictive models for airway device selection. Inclusion criteria were HRCT scans with normal thoracic findings and adequate inspiratory effort. Exclusion criteria included thoracic, pulmonary or cardiac abnormalities, prior airway surgery, presence of airway devices, or severe imaging artifacts. Data were analysed using t-test, one-way ANOVA, Pearson correlations, and multiple linear regression. Statistical significance was set at p < 0.05.

Results: Indian males exhibited significantly larger airways than females (tracheal length: 109.5 ± 8.9 mm vs. 100.5 ± 7.4 mm, p < 0.001; distal tracheal area: 311.3 ± 111.1 mm² vs. 227.6 ± 92.9 mm², p < 0.001). Notably, 54.5% of subjects had a more vertical left bronchus, contradicting classical anatomical dogma. High rates of short right main bronchi (< 23 mm) were observed in 49.5% of subjects, increasing the risk of double-lumen endobronchial tube misplacement. The distal tracheal diameter was strongly correlated with bronchial dimensions (r = 0.621, p < 0.001), providing evidence-based device selection.

Conclusion: This study provides the first population-specific normative data for central airway dimensions in Indian adults, revealing profound ethnic variations with immediate clinical implications for airway management, thoracic surgery, and personalised medical device design. The findings underscore the necessity of region-specific reference standards to optimise patient safety and highlight the influence of ethnicity on airway anatomy.

Introduction: Treatment of periprosthetic fractures around the elbow remains a challenge. The goal of this study was to present classification-based treatment strategies of periprosthetic fractures around elbow prosthesis.

Methods: This study was designed as a systematic review and meta-analysis of published articles in English or German language that investigated classification systems and treatment strategies of fractures around elbow prosthesis without timeframe limitations. Articles without full-text availability were excluded. The search included the following data bases: Medline, EMBASE, Cochrane and Web of Science (WoS). The fractures where classified according to the most commonly utilized classification system. Outcome parameters included follow-up time, bone union and range of motion. After deduplication title and abstract screening and full-text analyses were performed by two independent researchers. Risk of bias assessment was performed with the Revised Cochrane risk of bias tool (ROBINS 1) for non-randomized studies.

Results: This systematic review included 26 articles that included 11 reviews (42.3%), 12 case reports (46.1%) and 3 (11.6%) cohort studies. In total 85 patients were included with a mean age of 68.7 (SD 11.1) years. Most patients were female (n = 61, 73.5%). Fractures were all classified according to Mayo classification. In most reports, type 1 fractures without stem loosening were treated non-operatively, type 2 and 3 fractures without stem loosening with fracture fixation, type 2 fractures with stem loosening with revision arthroplasty. The time to bone union was comparable in fracture fixation versus revision surgery (18.2, SD 9.4 weeks vs. 12.3, SD 5.4 weeks, p = 0.294). The degree/ (or range) of extension was comparable in both groups (9.8, SD 11.2° versus 17.4, SD 16.6°, p = 0.335). The degree of flexion was comparable in both groups (117.5, SD 15.1° versus 127.9, SD 10.3°, p = 0.335).

Conclusion: Treatment of periprosthetic fractures around elbow arthroplasty remains a challenge. The treatment strategy is based on the location of the fracture and the stability of the elbow prosthesis. The lack of high-quality research prohibits a final evidence- based recommendation for the treatment of periprosthetic fractures around the elbow.

Background: In the high-stakes environment of the operating room (OR), patient safety depends not only on technical expertise but also on seamless communication, clear roles, and coordinated teamwork. Traditional approaches often overlook the relational and performative dimensions of surgical care.

Methods: This narrative article proposes a metaphorical framework that compares surgical practice to live theater, where each team member plays a rehearsed role, and protocols act as scripts. The study explores key themes such as preparation (rehearsals), intraoperative coordination (live performance), and structured debriefing (curtain call). The aim is to synthesize knowledge from clinical literature and human factors theory to provide a novel interpretive framework for improving patient safety in the operating room (OR). A selective literature review was conducted focusing on peer-reviewed publications related to surgical teamwork, communication, safety checklists, and non-technical skills. Sources were identified through PubMed and Google Scholar using relevant terms such as "surgical safety," "human factors in surgery," and "team communication."

Results: The metaphorical framework reveals that each member of the OR team-from the surgeon to the scrub nurse-is reimagined as a theatrical role, with their contribution being essential to the surgical outcome. Key concepts such as simulation training, checklists, psychological safety, and mutual accountability are highlighted as critical tools for enhancing performance and reducing preventable harm. The study emphasizes the importance of clear role definitions, team coordination, and continuous learning, similar to a theater production's preparation, performance, and reflection stages.

Conclusion: Viewing the OR through the lens of theater offers a novel, human-centered model for improving surgical safety. This conceptual framework promotes structured teamwork, shared mental models, and a culture where every action is intentional and every role is respected ensuring that each surgical performance prioritizes the patient's well-being above all.

Background: Hemodialysis is the most prevalent modality of renal replacement therapy. The durability of hemodialysis and its quality depend on consistent and reliable access to the patient's vascular system. In this systematic review we provide a comprehensive analysis of the predictors of primary arteriovenous fistula failure.

Methods: A systematic search was conducted in PubMed, Web of Science, ScienceDirect, and the WHO Virtual Health Library Regional Portal from database inception through March 2025. Search terms included combinations of 'arteriovenous fistula', 'failure', 'hemodialysis', 'end-stage renal disease', and 'risk factors'. Four reviewers independently screened titles and abstracts, with full texts assessed according to predefined inclusion criteria. Studies were eligible if they examined risk factors for primary arteriovenous fistula failure in adult patients on hemodialysis.

Results: A total of 38 studies were included in the systematic review. Early arteriovenous fistula failure was significantly associated with a distal location of the fistula, small arterial diameter, small vein diameter, low serum albumin level, female gender, diabetes mellitus, and decreased systolic and diastolic blood pressure.

Conclusion: This systematic review identified several key risk factors for early arteriovenous fistula failure in patients with end-stage renal disease (ESRD) undergoing hemodialysis. These factors should be considered from a patient safety perspective and included in the shared decision-making process with patients who are candidates for arteriovenous fistula surgery. Optimizing these factors may enhance fistula maturation and reduce the need for repeat vascular access procedures. However, recognizing that some risk factors may not be readily modifiable in ESRD patients, clinicians should balance optimization efforts with the urgency of establishing vascular access.

Surgical safety remains a critical yet often overlooked priority in low-resource countries, particularly in post-armed conflict settings like Somalia. Decades of instability have left the Somali healthcare system fragmented and severely under-resourced, contributing to a high burden of avoidable surgical complications and perioperative mortality. In response to these challenges, the World Health Organization (WHO) developed the Surgical Safety Checklist (SSC), a globally recognized tool designed to reduce surgical harm, enhance communication, and foster teamwork in operating theatres. Although widely adopted in many health systems, evidence on its implementation and effectiveness in Somalia has been notably absent. The country's unique constraints, including inadequate infrastructure, variable clinical training, and fluid surgical team structures, raise important considerations about the adaptability and sustainability of global safety initiatives in such environments. To address this gap, we implemented the WHO SSC in 15 hospitals across Mogadishu, aiming to evaluate its feasibility, measure improvements in adherence, and examine its influence on promoting a culture of surgical safety within resource-limited settings. Beyond improving procedural compliance, the intervention sought to determine whether structured training and frontline engagement could mitigate systemic barriers to safe surgical care. This study contributes valuable insights for global health stakeholders and policy-makers seeking to contextualize and scale evidence-based safety practices in settings characterized by conflict, institutional fragility, or chronic underinvestment in health systems.

Background: Meckel's diverticulum, a congenital anomaly of the gastrointestinal tract, is often asymptomatic but can present with complications such as inflammation, perforation, or obstruction. Misdiagnosis is common owing to its varied presentations, particularly when symptoms mimic other conditions such as urinary tract infections (UTI).

Case presentation: An 11-year-old boy presented with persistent suprapubic pain and dysuria for one week. Initial urine analysis revealed turbid urine with high numbers of red blood cells, leading to a diagnosis of urinary tract infection (UTI), and antibiotic treatment was initiated. However, the patient's symptoms persisted, with worsening clinical signs. A complete blood count revealed leukocytosis with neutrophilia, suggesting the need for further evaluation. A non contrast computed tomography (CT) scan revealed a thickened, blind-ended structure in the midline lower abdomen with gas, extensive fat stranding, and associated mesenteric lymphadenopathy, suggestive of perforated Meckel's diverticulum. The patient underwent laparoscopic exploration, which revealed an abscess caused by perforated Meckel's diverticulum adherent to the urinary bladder. Diverticulectomy and incidental appendectomy were performed via a stapling device. Pathology confirmed a perforation of Meckel's diverticulum with serofibrinous peritonitis and follicular appendicitis. The postoperative course was uneventful, with the patient resuming full oral intake by the fifth day and being discharged in stable condition.

Conclusion: This case emphasizes how Meckel's diverticulum can mimic a urinary tract infection, especially in pediatric patients with overlapping symptoms like suprapubic pain and dysuria. The delayed diagnosis highlights the importance of reconsidering rare causes when symptoms persist. Timely imaging was crucial in guiding effective treatment.