Perioperative Care and Operating Room Management最新文献_第3页

Machine learning surgery duration predictions compared to traditional methods: A systematic review 机器学习手术持续时间预测与传统方法的比较：系统综述

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2025-11-04 DOI: 10.1016/j.pcorm.2025.100581

Richard T. Park , Christopher H. Stucky , Chandler H. Moser

Introduction: Accurate estimation of surgical case duration is essential for operating room (OR) efficiency. We aimed to evaluate the performance of machine learning (ML) models to predict surgery duration compared to conventional estimation, and to explore the factors affecting ML performance and its practical implementation.

Methods: Following PRISMA guidelines, we searched literature using MEDLINE, Embase, and CINAHL for articles published between January 2019 and October 2024. Studies were eligible if they evaluated an ML-based model, reported performance data, and compared the models to traditional estimation methods. The risk of bias was assessed using the Prediction model Risk Of Bias Assessment Tool.

Results: Eleven studies met the inclusion criteria. Models trained on specific surgical populations generally outperformed broader models. Several studies had methodological issues, such as incomplete handling of missing data and limited validation. ML models typically improved accuracy over traditional estimates. The average improvement was 25.7 %, with the best models reducing error rates by 51 %. We found no correlation (r = −0.01) between the number of predictor variables and the percentage improvement in prediction accuracy.

Discussion: ML-based surgical duration prediction shows promise for improving OR scheduling efficiency. However, challenges remain, including the need for standardized reporting, robust external validation, and practical integration into existing workflows. The risk of bias and inconsistent reporting of validation methods reduces confidence in the generalizability of ML performance. Heterogeneity in study and model designs complicates direct comparisons. Adopting standardized ML model development and testing protocols for surgical duration prediction can better demonstrate its benefits.

准确估计手术病例持续时间对手术室效率至关重要。我们的目的是评估机器学习（ML）模型在预测手术持续时间方面的性能，并与传统估计相比较，探讨影响ML性能的因素及其实际实施。方法：按照PRISMA指南，我们使用MEDLINE、Embase和CINAHL检索2019年1月至2024年10月间发表的文献。如果研究评估了基于ml的模型，报告了性能数据，并将模型与传统估计方法进行了比较，则该研究是合格的。使用预测模型偏倚风险评估工具评估偏倚风险。结果：11项研究符合纳入标准。在特定手术人群上训练的模型通常优于更广泛的模型。一些研究存在方法学上的问题，例如对缺失数据的处理不完整和验证有限。ML模型通常比传统估计提高了准确性。平均改进为25.7%，最好的模型将错误率降低了51%。我们发现预测变量的数量与预测准确度提高百分比之间没有相关性（r = - 0.01）。讨论：基于ml的手术时间预测有望提高手术室调度效率。然而，挑战仍然存在，包括需要标准化的报告、健壮的外部验证，以及与现有工作流的实际集成。验证方法的偏倚和不一致报告的风险降低了对机器学习性能可泛化性的信心。研究和模型设计的异质性使直接比较复杂化。采用标准化的ML模型开发和测试方案进行手术时间预测可以更好地展示其优势。

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引用次数: 0

The future of percutaneous tracheostomy: Is it time to embrace intensivist-led bedside practice? 经皮气管切开术的未来：是时候接受强化医生主导的床边实践了吗？

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2025-11-01 DOI: 10.1016/j.pcorm.2025.100580

Amr Salah Omar , Mohamed Khalil

The evolution of percutaneous dilatational tracheostomy (PDT) reflects the growing procedural autonomy of intensivists and the shift toward resource-conscious, patient-centered critical care. Bedside PDT performed or led by trained intensivists or dedicated tracheostomy teams has been shown to be safe, cost-effective, and carries an important ethical advantage by avoiding transport-related risks and reducing preventable harm compared with surgical tracheostomy in the operating room. It avoids transport-related risks, enhances care continuity, and optimizes ICU workflow—benefits that proved vital during the COVID-19 pandemic. Broader adoption of intensivist-led bedside PDT should be viewed not merely as a clinical option, but as a professional and institutional imperative.

经皮扩张性气管切开术（PDT）的发展反映了重症医师日益增长的手术自主性，以及向资源意识、以患者为中心的重症监护的转变。由训练有素的重症医师或专门的气管切开术团队执行或领导的床边PDT已被证明是安全的，具有成本效益的，并且与手术室的气管切开术相比，通过避免与运输相关的风险和减少可预防的伤害，具有重要的伦理优势。它避免了运输相关的风险，提高了护理的连续性，并优化了ICU的工作流程——在2019冠状病毒病大流行期间，这些优势被证明至关重要。更广泛地采用强化医生主导的床边PDT不应仅仅被视为一种临床选择，而是一种专业和制度上的必要。

引用次数: 0

Examining the impact of the peer-mentor program on the clinical competence of surgical technology students at shiraz university of medical sciences 考察同伴导师计划对设拉子医科大学外科技术专业学生临床能力的影响

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2025-10-30 DOI: 10.1016/j.pcorm.2025.100579

Shaghayegh Garmanjani , Somayeh Gheysari , Mehdi Hasanshahi , Reza Tavakkol , Jamshid Eslami

Background

Peer-mentoring-based education is one of the most important educational aspects that constitutes a significant part of developing competent individuals. This study is a quasi-experimental study that investigates the impact of the peer-mentor program on the clinical competence of surgical technology students.

Methods

The present study is a quasi-experimental investigation conducted with 29 undergraduate students in the fourth semester of surgical technology, divided into control and intervention groups, with a pretest and posttest. The data collection tool was the Operating Room Nurses’ Clinical Competence self-assessment questionnaire, which was completed before and after the training. Descriptive statistics and independent-samples t-tests were used for data analysis.

Results

The results of this study indicated a statistically significant difference between the clinical competence scores before and after the intervention, demonstrating an increase in the clinical competence scores of students in both groups after the intervention (p < 0.05). The independent t-test showed that there was no statistically significant difference in the mean clinical competence scores between the two groups after the intervention (p > 0.05).

Conclusions

The results of this research indicated that the clinical competence scores of students who utilized the peer-mentoring educational method were similar to those of the instructor-led group, suggesting that this educational approach can be as effective as instruction by teachers. Therefore, it is essential to develop clinical educational programs that provide a pathway for academic growth and an appropriate environment for acquiring clinical skills in learners.

同伴导师制教育是教育中最重要的方面之一，是培养有能力的个体的重要组成部分。本研究是一项准实验研究，探讨同侪导师计划对外科技术学生临床能力的影响。方法对29名外科技术专业本科四学期学生进行准实验调查，分为对照组和干预组，进行前测和后测。数据收集工具为《手术室护士临床能力自评问卷》，分别于培训前后完成。数据分析采用描述性统计和独立样本t检验。结果本研究结果显示干预前后临床能力得分差异有统计学意义，干预后两组学生临床能力得分均有提高（p < 0.05）。经独立t检验，干预后两组患者的平均临床能力得分比较，差异无统计学意义（p > 0.05）。结论本研究结果显示，采用同侪导师制教育方式的学生临床能力得分与教师导师制教育方式的学生相似，表明同侪导师制教育方式与教师导师制教育方式同样有效。因此，必须发展临床教育计划，为学习者提供学术成长的途径和获得临床技能的适当环境。

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引用次数: 0

Tutorial on internal consistency assessment by Cronbach's alpha and McDonald’s omega Cronbach's alpha和McDonald 's omega内部一致性评估教程

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2025-10-21 DOI: 10.1016/j.pcorm.2025.100568

Farzan Madadizadeh , Sajjad Bahariniya

This tutorial study provides a comprehensive overview of internal consistency measures used in reliability analysis, focusing on six primary models: Cronbach's alpha, Kuder-Richardson methods (KR-20 and KR-21), Guttman's lambda-2, parallel and strict parallel methods, and McDonald's omega coefficient. The methods discussed are applicable primarily to psychometric instruments and questionnaire-based data commonly used in social, behavioral, and educational sciences. Internal consistency is crucial for assessing the reliability of measurement scales in these fields. The study reviews each method, detailing their theoretical underpinnings, assumptions, and practical applications, alongside software guidelines for implementation in SPSS, R, and STATA. It highlights the distinctions between these methods, particularly emphasizing the advantages of McDonald's omega over Cronbach's alpha for more accurate reliability estimates. This work aims to fill the gap in existing literature by providing a thorough comparative analysis and practical guidance for researchers seeking to measure internal consistency effectively.

本教程研究提供了在可靠性分析中使用的内部一致性措施的全面概述，重点是六个主要模型：Cronbach's alpha， Kuder-Richardson方法（KR-20和KR-21）， Guttman的lambda-2，并行和严格并行方法，以及McDonald's omega系数。所讨论的方法主要适用于社会、行为和教育科学中常用的心理测量工具和基于问卷的数据。内部一致性是评估这些领域测量量表可靠性的关键。该研究回顾了每种方法，详细介绍了它们的理论基础、假设和实际应用，以及在SPSS、R和STATA中实施的软件指南。它强调了这些方法之间的区别，特别强调了麦当劳的omega比Cronbach的alpha更准确的可靠性估计的优势。本工作旨在填补现有文献的空白，为寻求有效测量内部一致性的研究人员提供全面的比较分析和实践指导。

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引用次数: 0

Thermal decay of pre-warmed intravenous fluids prior to infusion: An experimental study 输注前预热静脉输液的热衰减：一项实验研究

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2025-10-17 DOI: 10.1016/j.pcorm.2025.100578

Kanta Hattori , Mitsuru Ida , Masahiko Kawaguchi

引用次数: 0

Evaluation of the perfusion index as a determinant of the depth of anesthesia; an observational study 评价灌注指数作为麻醉深度的决定因素；观察性研究

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2025-10-17 DOI: 10.1016/j.pcorm.2025.100577

Sooraj D. Desai, Anju R. Bhalotra, Keshav Gaur, Rahil Singh, Shweta Dhiman

Background

Reliable monitoring of nociception and depth of anesthesia remains limited. Most nociception monitors assess sympathetic and parasympathetic nervous system activity. Minimum Alveolar Concentration (MAC) reflects anesthetic potency, while Bispectral Index (BIS) assesses the level of unconsciousness. Perfusion Index (PI), derived from pulse plethysmography, decreases during sympathetic activation. Light anesthesia and nociceptive stimuli trigger sympathetic responses, leading to reduced PI.

Methods

This double-blinded observational study included 35 adult patients undergoing elective surgery under standardized general anesthesia (GA). PI, MAC, BIS, heart rate (HR), and mean arterial pressure (MAP) were recorded during induction, maintenance, and recovery. The primary objective was to assess changes in PI and its correlation with MAC. Secondary outcomes included correlations of PI with BIS, HR, and MAP.

Results

PI showed significant variation across all time points. It increased after induction of GA and decreased during surgical stimulation and recovery. No significant correlation was found between changes in PI and MAC (r² = 0.394, p = 0.052) or BIS (r² = 0.392, p = 0.053). A strong negative correlation was observed between PI and HR (r = –0.888, r² = 0.789, p < 0.001), and a strong positive correlation between PI and MAP (r = 0.795, r² = 0.631, p = 0.006).

Conclusions

PI was a sensitive early indicator of inadequate anesthesia or analgesia, preceding traditional signs of sympathetic activation. Although not correlated with MAC or BIS, its strong association with HR supports its potential role as a simple, noninvasive adjunct in intraoperative monitoring.

背景：对伤害感觉和麻醉深度的可靠监测仍然有限。大多数伤害感觉监测器评估交感和副交感神经系统的活动。最低肺泡浓度（MAC）反映麻醉效力，而双谱指数（BIS）评估无意识水平。在交感神经激活过程中，由脉搏体积描记得出的灌注指数（PI）下降。轻度麻醉和伤害性刺激触发交感神经反应，导致PI降低。方法采用双盲观察方法，对35例在标准化全身麻醉（GA）下择期手术的成人患者进行研究。在诱导、维持和恢复期间记录PI、MAC、BIS、心率（HR）和平均动脉压（MAP）。主要目的是评估PI的变化及其与MAC的相关性。次要结果包括PI与BIS、HR和MAP的相关性。结果spi在各时间点均有显著差异。它在GA诱导后增加，在手术刺激和恢复期间减少。PI与MAC （r²= 0.394,p = 0.052）、BIS （r²= 0.392,p = 0.053）无显著相关。PI与HR呈显著负相关（r = -0.888, r²= 0.789,p < 0.001）， PI与MAP呈显著正相关（r = 0.795, r²= 0.631,p = 0.006）。结论spi是麻醉或镇痛不充分的早期敏感指标，比传统的交感神经激活迹象更早。虽然与MAC或BIS无关，但其与HR的强相关性支持其在术中监测中作为简单、无创辅助手段的潜在作用。

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引用次数: 0

Intravenous Dexmedetomidine vs. Meperidine for managing shivering after spinal anesthesia in cesarean deliveries: a randomized trial 静脉注射右美托咪定与哌哌啶治疗剖宫产脊髓麻醉后的寒战：一项随机试验

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2025-10-15 DOI: 10.1016/j.pcorm.2025.100575

Nahid Manouchehrian , Alireza Mortazavi , Mohammad Nima Mehrabani

Background

Post-spinal anesthesia shivering is a common complication during cesarean delivery, causing patient discomfort and interfering with vital sign monitoring.

Objectives

This study compared the efficacy and safety of intravenous dexmedetomidine and meperidine for controlling post-spinal anesthesia shivering in cesarean deliveries.

Methods

In this randomized clinical trial, 246 parturients who developed shivering after spinal anesthesia were allocated to two groups. Group A received intravenous meperidine (0.5 mg/kg), and Group B received dexmedetomidine (0.5 µg/kg), both administered over 10 min after umbilical cord clamping. Shivering intensity, vital signs, and adverse effects were recorded and analyzed.

Results

The onset time of shivering was similar between groups (P = 0.081). The time to cessation of shivering was significantly shorter in the meperidine group (7.6 ± 4.6 min) compared to the dexmedetomidine group (9.7 ± 5.5 min) (P = 0.003). Shivering scores at 5- and 10-minute post-injection were significantly lower in the meperidine group (P < 0.05). Blood pressure was lower and heart rate higher in the meperidine group at early time points (P < 0.05), but these changes were transient and not clinically significant. Dexmedetomidine was associated with higher rates of bradycardia and hypertension (P = 0.001 and P = 0.005), while nausea and vomiting were more frequent with meperidine (P = 0.166). Meperidine demonstrated a faster time to shivering cessation, while dexmedetomidine had lower rates of nausea and vomiting.

Conclusion

Both drugs effectively controlled post-spinal anesthesia shivering. Meperidine demonstrated a faster time to shivering cessation, while dexmedetomidine had lower rates of nausea and vomiting. Further studies are needed to optimize dosing and assess long-term outcomes

脊髓麻醉后寒战是剖宫产术中常见的并发症，可引起患者不适并干扰生命体征监测。目的比较右美托咪定和哌哌啶静脉注射控制剖宫产脊髓麻醉后寒战的疗效和安全性。方法将246例脊髓麻醉后出现寒战的产妇随机分为两组。A组静脉滴注哌哌啶（0.5 mg/kg）， B组静脉滴注右美托咪定（0.5µg/kg），均在脐带夹紧后10 min内给药。记录和分析寒战强度、生命体征和不良反应。结果两组患者寒战发作时间相近（P = 0.081）。与右美托咪定组（9.7±5.5 min）相比，哌嗪组（7.6±4.6 min）停止颤抖的时间明显缩短（P = 0.003）。注射后5分钟和10分钟，哌啶组的寒颤评分明显降低（P < 0.05）。哌哌啶组在早期时间点血压较低、心率较高（P < 0.05），但这些变化是短暂的，无临床意义。右美托咪定与较高的心动过缓和高血压发生率相关（P = 0.001和P = 0.005），而恶心和呕吐更频繁使用哌嗪（P = 0.166）。哌嗪能更快地停止颤抖，而右美托咪定的恶心和呕吐率较低。结论两种药物均能有效控制脊髓麻醉后寒战。哌嗪能更快地停止颤抖，而右美托咪定的恶心和呕吐率较低。需要进一步的研究来优化剂量和评估长期结果

{"title":"Intravenous Dexmedetomidine vs. Meperidine for managing shivering after spinal anesthesia in cesarean deliveries: a randomized trial","authors":"Nahid Manouchehrian , Alireza Mortazavi , Mohammad Nima Mehrabani","doi":"10.1016/j.pcorm.2025.100575","DOIUrl":"10.1016/j.pcorm.2025.100575","url":null,"abstract":"<div><h3>Background</h3><div>Post-spinal anesthesia shivering is a common complication during cesarean delivery, causing patient discomfort and interfering with vital sign monitoring.</div></div><div><h3>Objectives</h3><div>This study compared the efficacy and safety of intravenous dexmedetomidine and meperidine for controlling post-spinal anesthesia shivering in cesarean deliveries.</div></div><div><h3>Methods</h3><div>In this randomized clinical trial, 246 parturients who developed shivering after spinal anesthesia were allocated to two groups. Group A received intravenous meperidine (0.5 mg/kg), and Group B received dexmedetomidine (0.5 µg/kg), both administered over 10 min after umbilical cord clamping. Shivering intensity, vital signs, and adverse effects were recorded and analyzed.</div></div><div><h3>Results</h3><div>The onset time of shivering was similar between groups (<em>P</em> = 0.081). The time to cessation of shivering was significantly shorter in the meperidine group (7.6 ± 4.6 min) compared to the dexmedetomidine group (9.7 ± 5.5 min) (<em>P</em> = 0.003). Shivering scores at 5- and 10-minute post-injection were significantly lower in the meperidine group (<em>P</em> < 0.05). Blood pressure was lower and heart rate higher in the meperidine group at early time points (<em>P</em> < 0.05), but these changes were transient and not clinically significant. Dexmedetomidine was associated with higher rates of bradycardia and hypertension (<em>P</em> = 0.001 and <em>P</em> = 0.005), while nausea and vomiting were more frequent with meperidine (<em>P</em> = 0.166). Meperidine demonstrated a faster time to shivering cessation, while dexmedetomidine had lower rates of nausea and vomiting.</div></div><div><h3>Conclusion</h3><div>Both drugs effectively controlled post-spinal anesthesia shivering. Meperidine demonstrated a faster time to shivering cessation, while dexmedetomidine had lower rates of nausea and vomiting. Further studies are needed to optimize dosing and assess long-term outcomes</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100575"},"PeriodicalIF":1.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Characterizing periods for rapid testing of bacterial pathogens at ends of surgical cases for interventions in the post-anesthesia care unit or hospital wards using discharge times of patients with and without postoperative healthcare-associated infections 在麻醉后护理单位或医院病房进行干预的手术病例结束时，使用有和没有术后医疗保健相关感染的患者的出院时间来描述细菌病原体快速检测的周期

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2025-10-15 DOI: 10.1016/j.pcorm.2025.100576

Franklin Dexter , Paul Cover , Randy W. Loftus

Background

Earlier studies showed that prevention of Staphylococcus aureus transmission through the anesthesia work area (e.g., from hands of the anesthesiologist to intravenous lumen) resulted in fewer postoperative healthcare-associated infections, specifically surgical site infections. Test results for contamination (e.g., of the anesthesia machine) guide anesthesia clinicians’ efforts. In the studies, a single national laboratory was used, providing such information at least several days later. Future clinical trials could use rapid assays to test reservoirs (e.g., intravenous lumen) at the end of the case for prompt treatment. Study designs depend on knowing how quickly results would be needed.

Methods

The retrospective cohort study was performed using data from 13,512 elective cases performed at a teaching hospital’s inpatient adult surgical suite over 12 months in 2023–2024. Postoperative healthcare-associated infections were obtained from International Classification of Diseases, Tenth Revision, Clinical Modification codes listed <91 days postoperatively, when diagnosed by a surgical team. Different periods from operating room exit were studied (e.g., 1.0, 2.0, and 4.0 h). For each endpoint, 99 % lower one-sided confidence limits for proportions were calculated using intercept-only logistic regression, with robust clustered variance estimation by day.

Results

After 1.0 and 2.0 h, there were 98.9 % (≥97.7 %) and 90.6 % (≥87.3 %) of patients who developed postoperative healthcare-associated infection who had not yet been discharged from the hospital, respectively. There were 89.0 % (≥84.9 %) and 44.2 % (≥38.2 %) who had not yet been discharged from the phase I post-anesthesia care unit. In contrast, at 4.0 h, the lower confidence limits were 76.1 % and 16.5 %, respectively.

Conclusions

Clinical trial designs to evaluate the use of rapid bacterial pathogen tests from anesthesia work areas should plan on results being obtained and used for treatment no greater than 2.0 h after patients exit operating rooms, but <1.0 h is not needed. Medical/surgical nurses throughout the hospital who care for surgical patients would need to be involved, not only post-anesthesia care unit teams.

早期的研究表明，预防金黄色葡萄球菌通过麻醉工作区域传播（例如，从麻醉师的手到静脉管腔）可减少术后医疗保健相关感染，特别是手术部位感染。污染（如麻醉机）的测试结果指导麻醉临床医生的工作。在这些研究中，使用了一个国家实验室，至少在几天后提供这些信息。未来的临床试验可以在病例结束时使用快速测定法来检测储存库（例如静脉内管腔），以便及时治疗。研究设计取决于了解需要多快得出结果。方法回顾性队列研究采用2023-2024年在某教学医院成人外科病房住院12个月的13512例选择性病例数据。术后医疗保健相关感染数据来自《国际疾病分类第十版临床修改代码》，列出了术后91天由外科团队诊断的病例。研究了从手术室出口开始的不同时间（如1.0、2.0和4.0 h）。对于每个终点，使用仅截距逻辑回归计算比例的99%较低的单侧置信限，并按天进行稳健的聚类方差估计。结果术后1.0 h和2.0 h未出院的患者分别为98.9%（≥97.7%）和90.6%（≥87.3%）。89.0%（≥84.9%）和44.2%（≥38.2%）的患者尚未从I期麻醉后护理病房出院。相比之下，在4.0 h时，下限分别为76.1%和16.5%。结论评价麻醉工作区域快速病原菌检测应用的临床试验设计应计划在患者离开手术室后不超过2.0 h内获得和用于治疗的结果，但不需要1.0 h。整个医院负责手术病人的内科/外科护士都需要参与，而不仅仅是麻醉后护理小组。

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引用次数: 0

Surgical time-outs: Ritual or real safety practice? 手术暂停：仪式还是真正的安全实践？

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2025-10-14 DOI: 10.1016/j.pcorm.2025.100573

Seyed Abolfazl Hosseini , Bahador Pourdel , Erfan Rajabi , Amirali Alizadeh

The surgical time-out, a core component of the WHO Surgical Safety Checklist, was introduced to prevent wrong-site surgery, patient misidentification, and other critical perioperative errors. While its theoretical effectiveness is supported by global data, recent evidence suggests that in many operating rooms, the practice has devolved into a symbolic and perfunctory routine. This commentary explores the gap between intention and real-world implementation, and offers practical, evidence-based strategies to reestablish the time-out as a meaningful safeguard in surgical care.

手术暂停是世卫组织手术安全核对表的核心组成部分，它的引入是为了防止手术部位错误、患者误诊和其他严重的围手术期错误。虽然其理论上的有效性得到了全球数据的支持，但最近的证据表明，在许多手术室，这种做法已经沦为一种象征性和敷衍的例行公事。这篇评论探讨了意图和现实世界实施之间的差距，并提供了实用的、基于证据的策略，以重建暂停作为外科护理中有意义的保障。

引用次数: 0

Proper management and execution of surgical counting: achieving consensus through a Delphi study 手术计数的正确管理和执行：通过德尔菲研究达成共识

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2025-10-14 DOI: 10.1016/j.pcorm.2025.100574

Francesco Silvestri , Caterina Cicala , Salvatore Pagliaro , Debora Formisano , Luca Ghirotto

Surgical counting is a critical, multi-professional safety practice aimed at preventing retained surgical items (RSIs), such as sponges, instruments, and sharps, during operative procedures. It is commonly defined as a rational, standardized, and replicable process designed to ensure that all items used intraoperatively are accurately accounted for at the time of wound closure. The failure of this process—retention of foreign bodies—is a rare but serious adverse event associated with significant clinical, organizational, and legal consequences, including infection, re-operation, prolonged hospitalization, increased costs, and, in severe cases, death. Despite the existence of numerous international guidelines, counting errors continue to occur, often despite a “correct count” being reported. Studies have shown that RSIs may occur in the presence of systemic factors such as time pressure, communication breakdowns, multitasking, and variable adherence to protocols. Internationally, surgical safety is guided by regularly updated, evidence-based recommendations issued by professional societies. In Italy, however, Recommendation No. 2/2008—based on WHO’s “Safe Surgery Saves Lives” initiative—remains the primary national reference document, yet it has not been updated in over 15 years and does not fully reflect evolving practices or recent literature.

Aim

this study aimed to explore current practices, perceptions, and critical issues related to surgical counting in Italy, drawing on the experience and knowledge of a multidisciplinary expert panel composed of operating room nurses, surgeons, and clinical risk managers.

Methods

to gather expert opinion, a three-round Delphi process was conducted to gather and refine expert opinions. A preliminary literature review informed the first-round questionnaire. Through iterative feedback and consensus thresholds, the study generated a set of validated statements aimed at improving surgical counting practices and informing future national guidelines.

Conclusion

the findings offer a structured, practice-informed contribution to updating Italy’s approach to surgical counting and promoting safer operative care.

手术计数是一项关键的、多专业的安全实践，旨在防止手术过程中保留手术物品（rsi），如海绵、器械和利器。它通常被定义为一个合理的、标准化的、可复制的过程，旨在确保术中使用的所有物品在伤口关闭时都被准确地计算在内。这一过程的失败——异物滞留——是一种罕见但严重的不良事件，与重大的临床、组织和法律后果相关，包括感染、再次手术、延长住院时间、增加费用，严重者甚至死亡。尽管存在许多国际指导方针，计数错误仍在继续发生，通常尽管报告了“正确计数”。研究表明，rsi可能发生在系统因素存在的情况下，如时间压力、沟通中断、多任务处理和对协议的不同遵守。在国际上，手术安全以专业协会发布的定期更新的循证建议为指导。然而，在意大利，基于世卫组织“安全手术拯救生命”倡议的第2/2008号建议仍然是主要的国家参考文件，但它在15年多的时间里没有更新，也没有充分反映不断发展的做法或最近的文献。本研究旨在探讨意大利手术计数的当前实践、观念和关键问题，借鉴由手术室护士、外科医生和临床风险管理人员组成的多学科专家小组的经验和知识。方法收集专家意见，采用三轮德尔菲法收集和提炼专家意见。初步的文献综述为第一轮问卷调查提供了依据。通过反复反馈和共识阈值，该研究产生了一套有效的声明，旨在改进手术计数实践并为未来的国家指南提供信息。结论：研究结果为更新意大利手术计数方法和促进更安全的手术护理提供了结构化的、实践知情的贡献。

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引用次数: 0