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Patient Safety in Surgery

Ryan Charles, Brandon Hood, Joseph M Derosier, John W Gosbee, Ying Li, Michelle S Caird, J Sybil Biermann, Mark E Hake
Providing quality patient care is a basic tenant of medical and surgical practice. Multiple orthopaedic programs, including The Patient Safety Committee of the American Academy of Orthopaedic Surgeons (AAOS), have been implemented to measure quality of surgical care, as well as reduce the incidence of medical errors. Structured Root Cause Analysis (RCA) has become a recent area of interest and, if performed thoroughly, has been shown to reduce surgical errors across many subspecialties. There is a paucity of literature on how the process of a RCA can be effectively implemented...
2016: Patient Safety in Surgery
Abdul Rafay Qazi, Furqan Ali Siddiqui, Salman Faridi, Urooj Nadeem, Nida Iqbal Umer, Zainab Saeed Mohsini, Muhammad Muzzammil Edhi, Mehmood Khan
BACKGROUND: Needle stick injuries (NSIs) have the potential of causing Hepatitis B and Hepatitis C, which is constantly adding to the burden of chronic liver disease in our country. It poses a risk to Health Care Workers (HCWs) and the patients they deal with. In order to limit the spread of these viruses, it is imperative that these HCWs be fully equipped with knowledge regarding prevention of NSIs and dealing with one, regardless of their designation. We therefore aimed to assess and compare the level of awareness about precautions for needle stick injuries amongst all those greatest at risk...
2016: Patient Safety in Surgery
Nicole Stornelli, Frank B Wydra, Justin J Mitchell, Philip F Stahel, Stefka Fabbri
BACKGROUND: Lower extremity acute compartment syndrome after gynecologic surgery in the lithotomy position is a rare, yet potentially devastating complication. A high level of suspicion is paramount for early recognition and mitigation of acute compartment syndrome originating from prolonged surgery in lithotomy position. CASE PRESENTATION: A 23-year-old female, gravida 1, para 0, underwent a laparoscopic salpingectomy for a ruptured ectopic pregnancy. Surgical time was 90 min...
2016: Patient Safety in Surgery
Jürgen W Schmitt, Christian Benden, Claudio Dora, Clément M L Werner
BACKGROUND: In recent years, the number of lung transplants has increased rapidly, with higher quality of life and improved survival rates in transplant recipients, including patients with advanced age. This, in turn, means that more transplant recipients will seek musculoskeletal care to treat degenerative joint disease and also trauma incidents. Safety concerns regarding elective and posttraumatic hip arthroplasty in transplant patients include an increased risk of infection, wound healing problems, periprosthetic fractures and loosening of the implants...
2016: Patient Safety in Surgery
Felix Oldhafer, Kristina I Ringe, Kai Timrott, Moritz Kleine, Wolf Ramackers, Sebastian Cammann, Mark D Jäger, Juergen Klempnauer, Hueseyin Bektas, Florian W R Vondran
BACKGROUND: The two-stage liver resection combining in situ liver transection with portal vein ligation, also referred to as ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy), has been described as a promising method to increase the resectability of liver tumors. However, one of the most important issues regarding the safety of this procedure is the optimal timing of the second stage at the point of sufficient hypertrophy of the future liver remnant. The recently developed liver maximum function capacity test (LiMAx) can be applied to monitor the liver function postoperatively and hence could be a useful tool for decision-making regarding the timing of the second stage of ALPPS...
2016: Patient Safety in Surgery
Sebastian Weckbach, Tugrul Kocak, Heiko Reichel, Friederike Lattig
BACKGROUND: The informed medical consent in surgery requires to some point basic medical knowledge. The treating physicians while explaining the details and risks of the recommended procedure often imply this. We hypothesized, that patients do not have adequate medical understanding to decide about the ongoing therapy and its potential complications based on knowledge jeopardizing the patients' safety. METHODS: We conducted a retrospective analysis of a prospective database using a multiple choice questionnaire with 10 basic questions about anatomy, clinical symptoms and therapies of spinal diseases in our spine clinic at a German university hospital...
2016: Patient Safety in Surgery
Vaidyanathan Subramanian, Bakul M Soni, Peter L Hughes, Gurpreet Singh, Tun Oo
BACKGROUND: Inflating the balloon of Foley catheter in urethra is a complication of urethral catheterisation. We report five patients in whom this complication occurred because of unskilled catheterisation. Due to lack of awareness, the problem was not recognised promptly and patients came to harm. CASE SERIES: A tetraplegic patient developed pain in lower abdomen and became unwell after transurethral catheterisation. CT pelvis revealed full bladder with balloon of Foley catheter in dilated urethra...
2016: Patient Safety in Surgery
Marc-Olivier Sauvain, Sandra Tschirky, Michael A Patak, Pierre-Alain Clavien, Dieter Hahnloser, Markus K Muller
BACKGROUND: The diagnosis of acute appendicitis in overweight patients is challenging due to the limited value of the clinical examination. The benefits of ultrasonography and abdominal CT have been studied in the general population, but there is limited data regarding their use in overweight and obese patients with suspected appendicitis. This study analyzes the role of preoperative radiological modalities in overweight patients with suspected appendicitis. METHODS: Retrospective analysis of a prospectively acquired database including 705 patients operated for suspected acute appendicitis...
2016: Patient Safety in Surgery
Grégoire Thürig, Jürgen Wilfried Schmitt, Ksenija Slankamenac, Clément M L Werner
BACKGROUND: The femoral neck fracture is one of the most common fractures in the elderly. A variety of methods and approaches are used to treat it. Total hip arthroplasty is a preferred approach in independent, mobile, elderly patients, given its more favorable long-term outcome. Our hypothesis is that the direct anterior approach in geriatric trauma patients has a lower dislocation-rate with the advantage of early recovery due to a muscle sparing approach and therefore early possible full weight-bearing...
2016: Patient Safety in Surgery
F C J Sim, D Angadi, G E Jarvis, M Porteous
BACKGROUND: Marking the surgical site is a well-established part of pre-operative protocol and errors in marking have been implicated in wrong site surgery incidents and are a significant patient safety issue. There are many commercially available marker pens and anecdotally very little consistency in which pen is used or the clarity of marking. Previous studies have shown subjective differences between different pens and the current paper sought to support this evidence with objective data and widen the investigation of commercially available pens...
2016: Patient Safety in Surgery
Pedro Leão, Paulo Figueiredo
BACKGROUND: Some paraplegic patients may wish undergo some surgical procedures, like urological procedures, without anesthesia. However, these patients can develop autonomic hyperreflexia if cystoscopy is performed without anesthesia. CASE PRESENTATION: We present a case of severe autonomic hyperreflexia in a 44-year-old male with spinal cord injury at the level of T4 during urologic procedure under sedation and analgesia successfully treated with intravenous lidocaine...
2016: Patient Safety in Surgery
Philip F Stahel, Pierre-Alain Clavien
The editors of Patient Safety in Surgery would like to thank all of our reviewers who have contributed to the journal in Volume 9 (2015).
2016: Patient Safety in Surgery
(no author information available yet)
[This corrects the article DOI: 10.1186/s13037-016-0093-x.].
2016: Patient Safety in Surgery
Thorsten Jentzsch, Stefan M Zimmermann, Flora Nicholls, Paolo Cinelli, Hans-Peter Simmen, Clément M L Werner
BACKGROUND: There is a need for effective drugs in the prevention and treatment of heterotopic ossifications (HO) after fractures. Echinomycin has been shown to prevent formation of HO in an animal model. However, before it may be considered as an option against HO, it needs to be studied whether it prevents fracture healing similar to non-steroidal anti-inflammatory drugs (NSAIDS). Therefore, the hypothesis was that echinomycin prevents fracture healing and callus formation. METHODS: In an experimental murine pilot study, standard blunt femur fractures were induced and retrograde intramedullary compression fixation of the femur was performed...
2016: Patient Safety in Surgery
Dirk Zajonz, Almut Zieme, Torsten Prietzel, Michael Moche, Solveig Tiepoldt, Andreas Roth, Christoph Josten, Georg Freiherr von Salis-Soglio, Christoph-E Heyde, Mohamed Ghanem
BACKGROUND: Modular mega-endoprosthesis systems are used to bridge very large bone defects and have become a widespread method in orthopaedic surgery for the treatment of tumours and revision arthroplasty. However, the indications for the use of modular mega-endoprostheses must be carefully considered. Implanting modular endoprostheses requires major, complication-prone surgery in which the limited salvage procedures should always be borne in mind. The management of periprosthetic infection is particularly difficult and beset with problems...
2016: Patient Safety in Surgery
Julia Blackburn
BACKGROUND: The General Medical Council states that effective note keeping is essential and records should be clear, accurate and legible. However previous studies of operation notes have shown they can be variable in quality and affect patient safety. This study compares the quality of operation notes against the National Standards set by the Royal College of Surgeons of England and the British Orthopaedic Association (BOA) for improving patient safety. METHODS: Information from Orthopaedic operation notes was collected prospectively over a 2-week period...
2016: Patient Safety in Surgery
Gunther H Sandmann, Sebastian Siebenlist, Florian B Imhoff, Philipp Ahrens, Markus Neumaier, Thomas Freude, Peter Biberthaler
BACKGROUND: The use of the extra-vertebral balloon osteoplasty is increasing and in the meanwhile it has become a safe surgical technique in the treatment of tibial head, distal radius and calcaneus fractures. In addition, we already could show in a biomechanical setup that the balloon osteoplasty might be a safe tool for reduction in the treatment of Hill-Sachs lesions, but clinical application has not been performed so far. CASE PRESENTATION: We report the case of a 53 year- old male patient who was referred to our Trauma department (level I trauma center) after the first manifestation of a posterior shoulder dislocation due to an epileptic seizure, originated in a- up to this date unknown -glioblastoma...
2016: Patient Safety in Surgery
Brigid M Gillespie, Teresa K Withers, Joanne Lavin, Therese Gardiner, Andrea P Marshall
BACKGROUND: Team-based group communications using checklists are widely advocated to achieve shared understandings and improve patient safety. Despite the positive effect checklists have on collaborations and reduced postoperative complications, their use has not been straightforward. Previous research has described contextual factors that impact on the implementation of checklists, however there is limited understanding of the issues that impede team participation in checklist use in surgery...
2016: Patient Safety in Surgery
Katarina Göransson, Johan Lundberg, Olle Ljungqvist, Elisabet Ohlsson, Gabriel Sandblom
BACKGROUND: Many adverse events occur due to poor communication between surgical and anesthesia unit personnel. The aim of this study was to identify strategies to reduce risks unveiled by a national survey on patient safety. METHODS: During 2011-2015, specially trained survey teams visited the surgery departments at Swedish hospitals and documented routines concerning safety in abdominal surgery. The reports from the first seventeen visits were reviewed by an independent group in order to extract findings related to routines in communication between anesthesia and surgical unit personnel...
2016: Patient Safety in Surgery
Piotr Kasina, Ann Tammelin, Anne-Marie Blomfeldt, Bengt Ljungqvist, Berit Reinmüller, Carin Ottosson
BACKGROUND: Lowering air-borne bacteria counts in the operating room is essential in prevention of surgical site infections in orthopaedic joint replacement surgery. This is mainly achieved by decreasing bacteria counts through dilution, with appropriate ventilation and by limiting the bacteria carrying skin particles, predominantly shed by the personnel. The aim of this study was to investigate if a single use polypropylene clothing system or a reusable polyester clothing system could offer similar air quality in the operating room as a mobile laminar airflow device-assisted reusable cotton/polyester clothing system...
2016: Patient Safety in Surgery
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