Patient Safety in Surgery最新文献

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.

Introduction: Urgent hospital readmissions within 30 days of discharge after surgery are a measure of the quality of health and social care. This study aims to identify the characteristics of patients at higher risk of readmission and the main reasons for readmission, stratified by type of surgery.

Methods: This cross-sectional study analysed the medical records of patients over 60 years of age in 2022 who had undergone surgery. Records came from hospitals covering an area of 890,000 inhabitants in Northern Italy (ULSS Marca Trevigiana). Risk factors for readmission included demographic characteristics, hospitalisation details, comorbidities, and procedures. Readmission rates and 95% CI were calculated by risk factor, type of intervention and reason for readmission. A logistic model was used to estimate the OR of readmission, adjusting for potential confounders.

Results: The overall 30-day readmission rate was 3.8% (3.5-4.3), with the highest rates after gastrointestinal surgery (49.7 per 1,000 admissions) and the lowest after skin-soft tissue surgeries (15.5 per 1,000 admissions). Multivariate analysis identified dementia (OR = 3.19), end-stage kidney disease or dialysis (OR = 2.84), and metastatic cancer (OR = 2.65) as strong predictors of readmission. Advanced age (75+), male gender, primary cancer, and anemia were also independent predictors. Infection was the main reason for readmission. Other significant causes were hemorrhage, thrombosis/embolism, and intestinal obstruction.

Conclusions: The study highlights the importance of identifying risk factors for readmission to improve transitions of care. Targeted interventions for high-risk populations, particularly those with dementia, renal disease, or cancer, are essential to improve postoperative outcomes and alleviate the burden of unplanned readmissions on healthcare systems.

Background: Operating room fires, though rare, pose serious risks to patient and operator safety. Among the known ignition sources, light-emitting surgical devices-including fiberoptic cables, headlamps, and light boxes-are increasingly recognized contributors. However, the true prevalence and underlying causes remain under-characterized in national surveillance data. This study hypothesized that operator error is a leading cause of light-source-related fires and sought to identify specific device types, procedural timing, and preventable risk factors involved in these adverse events.

Methods: Reports from the U.S. FDA's MAUDE database were analyzed for light source-related operating room fires from January 1, 2014, to January 1, 2024. Events were categorized by device type, procedural timing, root cause, and resultant injury.

Results: A total of 45 adverse events were analyzed. Most fires were associated with light sources (33.3%), light headlamps (31.1%), and fiberoptic cables (20%). Intraoperative fires comprised the majority (35.6%). Operator error accounted for 37.8% of cases, with common errors including device mishandling (35.2%) and failure to detect damage (17.6%). Only 13.3% required intra-procedural interventions; injuries included one patient burn and two operator injuries.

Conclusions: Most operating room fires involving light sources were linked to modifiable operator errors. These findings underscore the urgent need for preventive strategies-including mandatory training, regular equipment checks, and improved design standards-to reduce intraoperative fire risk and enhance surgical safety.

Wrong-level spine surgery remains a significant concern in spine surgery, leading to devastating consequences for patients and healthcare systems alike. This comprehensive review aims to analyze the existing literature on wrong-level spine surgery in spine procedures, identifying key factors that contribute to these errors and exploring advanced strategies and technologies designed to prevent them. A systematic literature search was conducted across multiple databases, including PubMed, Scopus, EMBASE, and CINAHL. The selection criteria focused on preclinical and clinical studies that specifically addressed wrong site and wrong level surgeries in the context of spine surgery. The findings reveal a range of contributing factors to wrong-level spine surgeries, including communication failures, inadequate preoperative planning, and insufficient surgical protocols. The review emphasizes the critical role of innovative technologies-such as artificial intelligence, advanced imaging techniques, and surgical navigation systems-alongside established safety protocols like digital checklists and simulation training in enhancing surgical accuracy and preventing errors. In conclusion, integrating advanced technologies and systematic safety protocols is instrumental in reducing the incidence of wrong-level spine surgeries. This review underscores the importance of continuous education and the adoption of innovative solutions to foster a culture of safety and improve surgical outcomes. By addressing the multifaceted challenges associated with these errors, the field can work towards minimizing their occurrence and enhancing patient care.

Background: Blunt abdominal trauma leading to gallbladder injury is rare and presents a diagnostic challenge. Here, we present scenario of gallbladder perforation due a blow from a fist to the abdomen.

Case presentation: A 30-years old male patient was admitted to University of Gondar comprehensive specialized hospital emergency department in Ethiopia due to blow from a fist on the right upper abdomen with a presumptive diagnosis of generalized peritonitis and underwent emergency laparotomy. The operative finding showed that, gallbladder was perforated at the fundus and a cholecystectomy was done. Postoperative time was uneventful and discharged on the 5th postoperative day.

Conclusion: Isolated gallbladder injury from a fist fight is rare, however, should be considered in the differential diagnosis of patients presenting with abdominal pain following minor blunt abdominal trauma.

Background: In-hospital handover of patient care is an essential but high-risk professional activity that often lacks transparency for patients. The purpose of this survey was to gain insight into surgical patients' perceptions of handover communications between doctors, incorporating patient and public involvement to enhance accessibility and understanding.

Methods: A cross-sectional, mixed-methods survey was developed with patient and public involvement and distributed to general surgery patients in two University Teaching Hospitals between 24 October 2023 and 21 July 2024. Comparative analyses of quantitative data were performed using McNemar's test for paired nominal data and Wilcoxon rank-sum test for continuous data. Free-text responses underwent thematic analysis to validate and expand on quantitative findings. Patient and public involvement partners contributed to study design, methodology, and the final manuscript.

Results: In total, 208 responses were received (52.3%). Significantly more patients reported having prior knowledge of nursing handovers (73.1%) compared to doctors' handovers (63.9%; x² = 14.53, p = 0.0002). Patient perceptions of the handover process were generally positive; although satisfaction declined significantly with weekend handovers (p < 0.05). Thematic analysis identified four themes: (1) the impact of poor inter-professional communication, (2) the importance of teamwork, (3) external factors influencing handover effectiveness, and (4) patient nonchalance about their care. The use of patient and public involvement in this study improved survey accessibility and understanding of the concept and importance of handover.

Conclusions: This study shows limited prior awareness of handover between doctors among surgical patients, especially the potential hazards that can arise if performed poorly. Patient and public involvement improved accessibility and understanding of the topic; however, challenges such as adequate training for meaningful engagement remain.