Perioperative Care and Operating Room Management最新文献

Background

Occurrence of anemia following colorectal cancer surgery is common and has been associated with decreased overall survival. We examine the perioperative hemoglobin change following minimally invasive colorectal cancer surgery. The aim is to assess if an association between decreasing hemoglobin and the existence of preoperative iron deficiency exists.

Methods

Registry based single center cohort study. Surgical colorectal cancer patients (2013–2019) being non-anemic prior to surgery and who underwent intended laparoscopic and curatively planned surgery were included. Hemoglobin change from pre-surgery to discharge was compared between patients with and without preoperative iron deficiency. Analysis was done using multivariate linear regression analysis. Changes in hydration status and inflammation were also accessed and compared to the change in hemoglobin.

Results

Out of a consecutive cohort of 1228 patients, 353 fulfilled the eligibility criteria and were available for analysis. The mean change in hemoglobin-concentration for all patients was -2.02 g/dl (SD +- 1.28) and an intraindividual decrease occurred in 95 % of the patients. Preoperative iron deficiency was not associated with the decrease in hemoglobin (correlation =-0.13, 95 % CI -0.43 – 0.18, p = 0.41). There was a statistically significant association between decreasing albumin levels and decreasing hemoglobin levels.

Conclusions

Following minimally invasive laparoscopic surgery, 95 % of non-anemic surgical colorectal cancer patients experienced a decreasing hemoglobin level. The median hemoglobin decrease was 2 g/dl during hospitalization. Preoperative iron deficiency was not associated with the decrease in hemoglobin levels.

Introduction

Mindful organizing as a team-level capability can help team members anticipate what can go wrong and recover quickly to maintain adequate team function and safe performance. This study aims to assess the mediating role of mindful organizing in the relationship between group safety climate and in-role and extra-role safety-related behaviors among 15 work teams in 15 operating rooms of a general hospital.

Method

Self-reported questionnaires were used to collect data concerning group safety climate, mindful organizing, and safety-related behaviors from a number of the operating room staff. In addition, behavioral markers were used to assess team functions regarding safety issues based on the assessment of the observer.

Results

The effects of group safety climate on mindful organizing (b = 0.44, p < 0.001) and mindful organizing on safety behavior (b = 0.69, p < 0.001) and safety citizenship behavior (b = 0.51, p < 0.001) were positive and statistically significant. Furthermore, the mediation effect of group safety climate through mindful organizing on safety-related behaviors was statistically significant. The results of assessing behavioral markers before, during, and after surgical operations showed that plastic surgery, obstetric and gynecologic surgery, orthopedic surgery, vascular surgery, and ear, nose, and throat surgery obtained lower ranks in effective team functioning concerning safety issues in the study hospital.

Conclusion

This study extends the research on how mindful organizing can affect the relationship between group safety climate and employees’ in-role and extra-role safety-related behaviors. These results can help increase our understanding of how mindful organizing might influence team-level reliability in surgical operations.

Background

Apart from the patients affected by the COVID-19 pandemic, it was extremely important to apply appropriate protective measures by minimizing the possibility of infection to patients in need of surgery, to provide personal protective equipment for the safety of the staff in the operating room and to take isolation measures for cases where COVID-19 was suspected. The purpose of this phenomenologically designed multi center study was to examine the experiences of operating room nurses during the COVID-19 pandemic.

Methods

In depth semi-structured interviews for an average 45 to 60 minutes were conducted with 14 operating room nurses. Data analysis was performed using MAXQDA 20 software, and the descriptive and relational analysis method was used. A total of 330 primitive code were obtained.

Results

As a result of data analysis, 6 subcodes, 32 codes, 17 categories and three themes were defined. The themes were defined: (a) categories of the theme of psycho-social dilemma: feelings about the pandemic, feelings about the test result, and feelings regarding case management, (b) categories of the theme of management of corporate risk perception: precautions, closure to the recovery unit, patient admission process, team and environment preparation process, team-patient relations, surgery process, post-operation process and training and (c) categories of the theme of process challenges: difficulty of working conditions, ignorance, appropriations/ payment injustice, loss of time, increased workload and lack of protective equipment.

Conclusion

We determined that the participants had extensive experience. The results showed it is important to provide adequate equipment, to provide training, to eliminate the appropriations/ payment injustice and to provide psychosocial support to the operating room nurses during the global epidemic.

Background

There is a high prevalence of perioperative anxiety and pain in patients undergoing various types of surgical procedures. Preoperative anxiety can worsen postoperative pain and lead to poor postoperative outcomes, including mortality and morbidity.

Aim

The purpose of this systematic review was to investigate the effectiveness of music therapy in reducing perioperative anxiety and pain.

Methods

Randomized controlled trials (RCTs) published between 2010 and 2023 were searched on CINHAL, Medline, PubMed, Cochrane, Science Direct, and Google Scholar. The RCTs were synthesized by combining a narrative synthesis approach and evidence levels approach. The quality assessment of the studies was performed using the CASP Checklist for RCTs.

Results

It was found that there is moderate evidence supporting the effectiveness of music therapy in reducing preoperative anxiety, as supported by multiple RCTs of moderate methodological quality. However, there was inconclusive evidence regarding the effectiveness of music therapy in reducing postoperative pain because of inconsistent findings between moderate-quality RCTs.

Conclusion and Implications

The findings of this systematic review support previous reviews that have demonstrated the effectiveness of music therapy in reducing preoperative anxiety. However, the unique evidence synthesis approach undertaken in this systematic review yielded findings inconsistent with previous reviews that have supported the effectiveness of music therapy in reducing postoperative pain. Therefore, music therapy can be used as an intervention to reduce preoperative anxiety. However, it should be used cautiously for postoperative pain treatment in the absence of preoperative anxiety. Future RCTs should address the high risk of bias noted in the reviewed RCTs due to the non-blinding of participants and investigators.

We performed a narrative review of bypass of the phase I post-anesthesia care unit (PACU) following general anesthesia to gain insight into ways to reduce the time until patients are ready for PACU discharge following general anesthesia. Web of Science and PubMed literature searches were performed. Publications’ references and citations were examined. The Scale for the Assessment of Narrative Review Articles’ six components were satisfied. The 14 articles included 17 studies, with nearly all patients being adults. Most studies’ patients underwent outpatient surgery with an average surgical duration of less than 100 min . The studies applied several different, but similar, criteria to choose if patients bypass the PACU. Notably, 13 of 17 studies and all five with the largest observed bypass rates used some version of the White-Song fast-track bypass criteria. Propofol was used uniformly for induction of general anesthesia. Most studies included at least one antiemetic prophylactically, a local anesthetic administered by the surgeon, and a non-opioid analgesic. The six studies with the largest observed bypass rates used remifentanil or restricted use of intraoperative opioids. We then considered economics. While achievable PACU bypass rates are insufficient to reduce healthcare costs, reducing mean PACU time markedly can lower the nursing labor costs, the total time until the last patient exits the PACU, and the incidence of patients recovering in operating rooms because of unavailable PACU nurses or beds. We examined probability distributions of brief patient recovery times by using Gas Man, an uptake and distribution software program, simulating times until reaching constant incremental reductions (0.1  %) in vessel-rich concentrations of desflurane and sevoflurane once the vaporizer was set to zero. Results showed that simulated recovery from volatile anesthetics can have recovery times appearing log-normal, as seen empirically. Thus, patients already meeting discharge criteria upon PACU arrival can be the far-left fraction of one population of patients. The implication is that the narrative review results for PACU bypass provide insight into how to have more patients with very brief times to recovery. Therefore, future studies should quantify the effectiveness and economic benefits of anesthesia practitioners aiming not for PACU bypass, per se, but rather that the patients meet PACU discharge criteria by the 5–10 min after unit arrival when the practitioner has completed PACU handoff and finished documentation in the anesthesia record.

Background

Surgical Instrument Errors (missing, broken, bioburden/contamination etc.) account for significant delays in the operating room. During sterile processing, instruments must be inspected for correctness, functionality, and cleanliness (bioburden) prior to packaging for sterilization. The environment where these tasks are performed is typically high stress and high throughput. There is a growing body of research in human performance that indicates that under stress, the skill of human visualization (inspection and identification) deteriorates. Furthermore, error modeling of sterile processing of surgical instruments suggests that the tasks at highest risk for errors involve human visualization. Reporting of Surgical Instrument Errors at our institution falls to OR staff and, during the period of this study, was done through a mechanism termed the Patient safety notice or PSN. PSNs are filed via computer through the healthcare system website. There is no integration or linkage of the PSN to the electronic medical record and information in all fields must be typed in as it does not automatically populate. We hypothesized that the most common PSNs reporting Surgical Instrument Errors would involve tasks of visualization (inspection, identification). Accordingly, the most common reported Surgical Instrument Errors would be missing instruments, bioburden/contamination, and broken instruments. We also hypothesized that due to the complexity and lack of both data automation and integration with the electronic medical record in filing PSNs, the majority of PSNs reporting Surgical Instrument Errors would be incomplete. To test these two hypotheses, we analyzed one year's worth staff reported Surgical Instrument Error rates at two hospitals with the operating rooms at both locations serviced by a single sterile processing facility.

Methods

This study was conducted at a major healthcare center that houses 38 ORs located at 3 sites (Children's (8), Adult inpatient (24) and Adult outpatient (6)) all of which share a sterile processing facility. Staff reported Patient Safety Notices (PSNs), a reporting mechanism for safety events, were collected from July 2019 through June of 2020. PSNs reporting the following Surgical Instrument Errors: missing instrument (listed on the count sheet but absent from the tray), broken instrument, assembly or packaging error, wrong instrument, failed sterilization/bioburden/contamination, fleet management (trays missing), extra instrument and transport errors were identified. Raw annual rates of reported Surgical Instrument Errors were determined for each hospital. Rates per surgical service line (percent affected cases) per hospital were then determined by dividing the annual number of reported errors per service by the annual number of cases per service line. Whether the instrument error affected the sterile field was determined as well. An analysis of bioburden/contamination er