Operating Room Research Articles

Metaphorical Perceptions of Operating Room Staff Towards the Concept of Pressure Ulcer: A Qualitative Study

Objective: To explain the perceptions of the operating room staff about pressure ulcers through metaphors. Materials and Methods: A descriptive qualitative research design was used. In the study, it was aimed to reach the entire universe, not choosing a sample. A total of 83 operating room staff participated in the study which 45 of them were operating room nurses, 38 of them were anesthesia technicians. The data were collected face to face with the descriptive features form and semi-structured interview form created by the researchers. In the semi-structured interview form, the operating room workers were asked to complete the sentence “Pressure ulcer is like ... because ...”. The data were analyzed with the "content analysis" method, which is one of the qualitative analysis methods. Results: Operating room staff generated a total of 25 types of metaphors for the concept of pressure ulcers and expressed 83 opinions for them. The first five most mentioned metaphors by the operating room staff were icebergs, matryoshka, storm after a sunny day, swamp, garden care and cracked vase, respectively. 19 of these metaphors were repeated nine to two times, and six of them were repeated once. Conclusion: Metaphors can be used as a powerful research tool in understanding and revealing the cognitive images of operating room staff regarding the concept of pressure ulcers. This study gives clues about how operating room staff imagine the concept of pressure ulcer.

Benefits of Bedside Open Tracheostomy: A Safe and Cost-Effective Alternative to the Operating Room.

Tracheostomy is a commonly performed procedure in Otolaryngology and can be performed in different settings. We evaluate patient characteristics and cost efficacy of tracheostomy at the bedside versus operating room (OR). Retrospective chart review was performed for adult intensive care unit (ICU) patients who underwent tracheostomy from 2020 to 2023. Data and cost of procedures were analyzed using descriptive statistics. One hundred and sixty-five patients were included. One hundred and thirty-four (81.2%) patients underwent bedside tracheostomy. Age, sex, and BMI were not significantly different. Average time from consult to procedure and operative time was significantly shorter (p = 0.03; 0.008). There were no differences in postoperative complications, 30-day mortality, ICU length of stay (LOS), or overall LOS. Tracheostomy at the bedside offered a 73.1% cost reduction compared with performed in the OR. Advantages of bedside tracheostomy include decreased operative time, time from consult to procedure, and cost reduction for the hospital system. We advocate for consideration of bedside tracheostomy when appropriate.

An Examination of Work-Family Conflict and Influencing Factors Among Operating Room Nurses: A Cross-Sectional Analysis

An Examination of Work-Family Conflict and Influencing Factors Among Operating Room Nurses: A Cross-Sectional Analysis

A Familiar Working Environment Influences Surgeon's Stress in the Operating Room: A Multi-Specialty Prospective Cohort Study.

To determine the influence of operating room familiarity on surgeon stress. Regulating surgeon stress may improve patient safety. This study evaluated how assisting surgeon and operating room familiarity influence intraoperative heart rate variability among surgeons. Attending surgeons from seven specialties within four university hospitals in France were enrolled from 11/01/20-12/31/21. Vagal tone, an indicator of stress derived from heart rate variability, was assessed during the first five minutes after incision using the root mean square of successive differences (RMSSD). Higher RMSSD values indicate greater vagal tone. Team familiarity was quantified as the cumulative time the attending and assisting surgeons had operated together in the past, while operating rooms in which the surgeon conducted >10% of their operations were termed familiar. The effect of each on the RMSSD was assessed via a linear mixed-effect model adjusting for the random effect of the surgeon and possible confounders. Overall, 643 surgeries performed by 37 surgeons were included. Median surgeon age was 49 years, 29(78.4%) were male, and 22(59.5%) were professors. Surgeons spent an average of 21.2 hours with the assisting surgeon prior to surgery and conducted 585(91.0%) of their operations in a familiar operating room. For every 10 additional hours spent operating together, ln(RMSSD) significantly increased by 0.018 (95%CI: 0.003 to 0.033, P=0.016). Familiar operating rooms also tended to increase surgeon ln(RMSSD) [0.098 (95%CI: -0.007 to 0.203, P=0.068)]. Familiar assisting surgeons, and potentially operating rooms, increased surgeon vagal tone. Maintaining a stable operating room environment may improve surgeon stress and patient care.

6G networks for the operating room of the future

Abstract Technical setups in today’s operating rooms (ORs) are becoming increasingly complex, especially with the integration of applications which rely on the fusion of multiple information sources. While manufacturers have already started to make use of such approaches, the quest for fully integrated ORs becoming standard is still ongoing. We describe a variety of state-of-the-art projects that envision an OR of the future in order to identify missing building blocks. While these initial implementations of sensor fused ORs have shown to be promising, all current proposals lack a scalable networking backbone that serves the needs of future applications. We therefore discuss how the coming 6G standard’s envisioned advancements can provide a flexible and intelligent platform to enable the fully integrated OR of the future.

Unveiling the dynamics of intraoperative contamination in total hip arthroplasty: the discrepancy between particulate and microbial contamination in surgical site infection risk

BackgroundSurgical site infection (SSI) is a major problem following total hip arthroplasty (THA). This study investigated the impact of a standard intraoperative routine where the surgical team wears full-body exhaust suits (space suits) within a laminar airflow (LAF)-ventilated operating room (OR) on environmental contamination. Our primary objective was to identify potential modifiable intraoperative factors that could be better controlled to minimize SSI risk.MethodsWe implemented an approach involving simultaneous and continuous air sampling throughout actual primary cementless THA procedures. This method concurrently monitored both airborne particle and microbial contamination levels from the time the patient entered the OR for surgery until extubation.ResultsAirborne particulate and microbial contamination significantly increased during the first and second patient repositionings (postural changes) when the surgical team was not wearing space suits. However, their concentration exhibited inconsistent changes during the core surgical procedures, between incision and suturing, when the surgeons wore space suits. The microbial biosensor detected zero median microbes from draping to suturing. In contrast, the particle counter indicated a significant level of airborne particles during head resection and cup press-fitting, suggesting these procedures might generate more non-viable particles.ConclusionsThis study identified a significant portion of airborne particles during the core surgical procedures as non-viable, suggesting that monitoring solely for particle counts might not suffice to estimate SSI risk. Our findings strongly support the use of space suits for surgeons to minimize intraoperative microbial contamination within LAF-ventilated ORs. Therefore, minimizing unnecessary traffic and movement of unsterile personnel is crucial. Additionally, since our data suggest increased contamination during patient repositioning, effectively controlling contamination during the first postural change plays a key role in maintaining low microbial contamination levels throughout the surgery. The use of sterile gowns during this initial maneuver might further reduce SSIs. Further research is warranted to investigate the impact of sterile attire on SSIs.

The Effect of Operating Room Tour Video on Pre-Anesthetic Anxiety in Sectio Caesarea Patients

Background: Preoperative anxiety in patients undergoing cesarean sections (CS) can significantly impact both psychological well-being and physiological responses, potentially affecting the success of anesthesia. An educational intervention, such as an Operating Room (OR) Tour video, may alleviate anxiety by familiarizing patients with the surgical environment and process. Purpose: To determine the effect of an Operating Room Tour video on pre-anesthetic anxiety levels in CS patients. Methods: This study employed a pre-experimental design with a pretest-posttest approach to assess the impact of the video on pre-anesthetic anxiety in 30 CS patients at Cilacap General Hospital. Anxiety levels were measured using the Visual Analog Scale for Anxiety (VAS-A) before and after the intervention. Statistical analysis was conducted using the Wilcoxon signed-rank test to evaluate the significance of the change in anxiety levels. Results: The findings revealed a significant reduction in anxiety following the video intervention. Prior to the intervention, 43.3% of participants experienced moderate anxiety, while post-intervention, 66.7% reported only mild anxiety. The Wilcoxon test confirmed the significant impact of the OR Tour video on reducing pre-anesthetic anxiety (p = 0.011, p < 0.05). Conclusion: The use of an Operating Room Tour video is an effective strategy to reduce preoperative anxiety in CS patients. This educational intervention could be a valuable addition to pre-anesthesia care, improving patient comfort and potentially contributing to better surgical outcomes.

Ultrasound-guided transversalis fascia plane block or transversus abdominis plane block for recovery after caesarean section: A randomised clinical trial.

Caesarean section is a widely performed surgical procedure that often results in moderate-to-severe postoperative pain. If left untreated, this pain can lead to short-term and long-term consequences. Transversalis fascia plane (TFP) block and transversus abdominis plane (TAP) block are among the regional anaesthesia techniques employed for managing pain after a caesarean section. We aimed to compare the impact of these two blocks on the quality of recovery in patients undergoing elective caesarean section under spinal anaesthesia. A single-centre, double-blind, randomised trial. Operating room, postanaesthesia recovery unit, and ward in a tertiary hospital. Ninety-three patients (ASA 2 to 3) were recruited. After exclusion, 79 patients were included in the final analysis: 40 in the TFP block group and 39 in the TAP block group. After surgery, participants received either TFP block (20 ml 0.25% bupivacaine for each side) or TAP block (20 ml 0.25% bupivacaine for each side). The primary outcome was the difference in obstetric quality of recovery 11-Turkish (ObsQoR-11T) scores between groups. Secondary outcomes included pain scores, opioid consumption and incidence of opioid-related complications. The mean ObsQoR-11T score was higher in the TFP block group compared with the TAP block group (97.13 ± 6.67 points vs. 87.10 ± 9.84 points, respectively; P < 0.001). The pain scores in the TFP block group were slightly lower between postoperative 4 and 24 h. The mean total morphine consumption was 15.08 ± 2.21 mg in the TFP block group and 22.21 ± 3.04 mg in the TAP block group ( P < 0.001). More patients required rescue analgesia between 4 and 8 h in the TAP block group [2.00 (5.00%) vs. 9.00 (23.08%), P = 0.02]. No significant differences were observed between groups in terms of opioid-related side effects. TFP block used for analgesic purposes yielded a better quality recovery period than TAP block and also reduced opioid consumption. Clinicaltrials.gov (NCT05999981). http://links.lww.com/EJA/B6 .

Medical Student Role in the Cardiothoracic Operating Room: A Needs Assessment to Optimize Engagement

BackgroundFocused preparation for the cardiothoracic operating room (CTOR) may optimize intraoperative engagement and medical student interest, but such resources are lacking. We sought to characterize student educational needs in the CTOR to guide resource development. MethodsA web-based survey targeting cardiothoracic surgeons, trainees, and operating room staff was distributed to identify areas for student improvement in the CTOR. Concepts investigated explored common student mistakes and expectations for knowledge and participation in the CTOR. Descriptive analyses were performed on multiple-choice polls and open-ended responses. ResultsPolls received a mean of 317 responses (range, 222-504) and 20 open-ended comments. The most frequently cited student mistake was failure to understand their role in the CTOR (164 [32.5%]), followed by inappropriate chatting (141 [28.0%]) and breaking sterility (132 [26.2%]). Poll respondents valued students’ understanding of how to be helpful in the CTOR (101 [45.5%]) in addition to knowing what can or cannot be touched (47 [21.2%]) and basics of cardiopulmonary bypass (43 [19.4%]). Respondents indicated that students should assume active roles (84 [36.7%]), ask questions (66 [29%]), and help with minor tasks (41 [17.9%]). Respondents reported that students benefited most when they understood patient-specific clinicopathologic factors and basic operative steps. ConclusionsWe identified several areas for student improvement in the CTOR. Development of educational resources addressing these issues may enhance interest and augment recruitment of students to cardiothoracic surgery.

Robotic versus open pancreaticoduodenectomy in octogenarians: a comparative propensity score analysis of perioperative outcomes

BackgroundCompared to open pancreaticoduodenectomies (OPD), the robotic (RPD) approach decreases the rate of complication and the length of stay (LOS). However, it remains unknown if these benefits persist in octogenarians, who are at higher risk for perioperative morbidity and mortality. MethodsA retrospective analysis of the ACS-NSQIP database was performed to identify patients aged 80 years or older who underwent PD for pancreatic adenocarcinoma between 2015–2021. Patients who underwent RPD or OPD were compared using inversed probability weighting of the propensity score. Outcomes assessed include operative time, LOS, non-home discharge, major complications, unplanned readmission, return to the operating room, mortality, and clinically relevant postoperative pancreatic fistula. ResultsOf 30,751 patients, 1720 were octogenarians. One thousand six hundred twenty-five patients (94 %) underwent OPD, and 95 (6 %) underwent RPD. RPD was significantly associated with a reduced incidence of major complications (32.6 % vs. 45.6 %; p < 0.01) and a lower rate of non-home discharge (24.7 % vs. 34.3%; p < 0.05). However, RPD was associated with a longer operative time (438 min vs. 342 min; p < 0.0001). There was no difference in other assessed outcomes. ConclusionRPD may reduce major postoperative complications and non-home discharges compared to the open approach for octogenarians.

The fault in our nature: Error rates in a human observation study on surgical instrument errors in the OR

BackgroundErrors in sterile processing of surgical instruments result in wasted chargeable operating room minutes. Data delineating this problem have been generated primarily through human observation and reporting. Given the inherent error rate in human tasks, we hypothesized that the observed rate of surgical instrument errors per case per day would increase over a six-week longitudinal study as observers became more familiar with their environment and more comfortable identifying errors. MethodsA previously published dataset on surgical instrument errors was analyzed for the average errors per case per day over six weeks. Errors per case per day were compared to the percentage of inpatient cases for each respective date since the error rate in inpatient cases is twice that of outpatient cases. ResultsWhile the average errors per case per day increases from 0.28 to 0.62, indicating a potential increase over time, no statistically significant trend was found (p = 0.157). A positive but modest correlation was observed between inpatient percentage and error rates (Pearson correlation = 0.344), nearing statistical significance (p = 0.068). The inpatient case percentage remained stable over time, with no significant trend detected (p = 0.284). ConclusionsHuman observation is a critical tool for defining waste arising from sterile processing errors. While the gradual increase in errors per case per day increases, the variability cannot be attributed to the initial adaptation the observer's environment. Future studies should assess inter-rated reliability and explore alternative automated observation methods to have a more accurate measurement of the number of errors observed.

Research on the evolution and venting characteristics of gasoline–air mixture explosions in confined pipeline trench spaces

In recent years, international energy cooperation has become more extensive, and the safe and reliable transportation of oil and gas resources has become increasingly important. However, storage and transportation sites can have confined spaces in engineering practice, which can lead to safety problems. There is a risk of gasoline–air mixture explosions in confined spaces such as pump rooms, valve operation rooms, and inspection wells, particularly in Class B and Class C pipeline trench areas that utilize non-sand-filled trenches or where the local depth exceeds 2.0 m. These locations are equipped with doors, manholes, or ventilation openings for personnel access within oil storage zones. To investigate the combustion characteristics of gasoline–air mixture explosions in such confined spaces, experimental research was conducted on a simulation platform (L/D = 15, V = 0.015 m3). The findings reveal the following: (1) the most hazardous initial gasoline–air mixture volume fraction for ignition at the upper ignition point is 1.7%; (2) the morphology of the internal flame evolves through four distinct stages, with the post-explosion flame shapes resembling “brush-like” and “mushroom cloud” formations; (3) low YCH = 1.1%, medium YCH = 1.7%, and high YCH = 2.3% volume fractions of hydrocarbons were selected to analyze the progression of the explosion development process; (4) the external overpressure distribution during venting explosions, with varying initial gasoline–air mixture volume fractions, conforms to the function y = ae−bx as the distance L varies, with venting pressure waves exhibiting a trend of exponential decay.

A Retrospective Multicenter Study of Operating Room Extubation and Extubation Timing following Cardiac Surgery

BackgroundIn an effort to enhance recovery after cardiac surgery, intraoperative extubation has been targeted as possibly beneficial. This multi-center cohort study aimed to assess this by evaluating the outcomes of OR extubation versus extubation within six hours of intensive care unit arrival (early ICU extubation). Furthermore, we assessed time to ICU extubation and mortality and morbidity. MethodsPatients undergoing on-pump cardiac surgery across 79 hospitals between 2011-2020 were included to 1) compare outcomes among OR extubation and early ICU extubation patients, and 2) assess time to overall ICU extubation and outcomes. ResultsThe overall study cohort comprised 163,982 patients, including 95,982 patients [ [ OR extubation : n= 2,529 (2.6%)and early ICU extubation : n= 93,453 (97.4%)] who underwent comparison of OR with early ICU extubation. Following overlap weighting, OR extubation patients had longer OR times (5.6 vs. 5.1 hours, p < 0.0001), and higher rates of reintubation (5.2% vs 2.9%, p=0.003), prolonged ventilation (3% vs 2%, p = 0.021), reoperation for bleeding (1.5% vs 0.7%, p < 0,01), pneumonia (1.9% vs. 1.1% , p < 0.006), and greater in-hospital mortality on multivariable regression (OR 1.34, p < 0.001). OR extubation patients at centers with low OR extubation rates (< 10%, N=60) had higher mortality (odds ratio 1.6, p = 0.001). Beyond 22 hours of postoperative ICU ventilation, the risk of morbidity and mortality increased significantly . ConclusionsFew cardiac surgery patients are extubated in the OR, which is associated with no clinical benefit and with increased morbidity. Cardiac surgery programs should reconsider OR extubation following cardiopulmonary bypass. Additionally, increased intubation time, in particular > 22 hours, is associated with an increase in adverse outcomes.

Robotic One Anesthetic Diagnosis and Treatment: A Novel Program for Lung Cancer Care

BackgroundEarly diagnosis and treatment of lung cancer can improve patient outcomes. To reduce the delay between diagnosis and treatment, we initiated a Robotic One Anesthetic Diagnosis and Treatment (ROADAT) program for lung nodules that combined robotic navigational bronchoscopy, liquid rapid on-site evaluation (ROSE), and surgical resection in the same setting. MethodsA retrospective review was conducted of patients who underwent the ROADAT procedure from December 1, 2021, through January 31, 2024. These patients were compared with sequential controls from the same time window, who would have been ROADAT candidates but underwent diagnosis and treatment using a standard lung nodule workup. ResultsThere were 36 patients in the ROADAT group and 35 controls. Of the 36 ROADAT patients, 31 (86%) underwent lung resections. When final pathology was available, ROSE was concordant in 91% (29 of 32) of cases. Compared with robotic lobectomies alone, ROADAT procedures that resulted in lobectomies added 73 minutes (P = .003). However, total operating room time for when lobectomy and biopsy were done in separate settings was 54 minutes shorter in the ROADAT group (P = .028). Direct (ROADAT, $19,244; controls, $21,737; P = .004) procedure costs and total (ROADAT, $26,668; controls, $29,882; P = .005) procedure costs were lower in the ROADAT group for patients who underwent lobectomy. Time from detection to resection was 35 days shorter in the ROADAT group (ROADAT, 82 days; controls, 117 days; P = .001). ConclusionsThe ROADAT procedure reduced time from nodule detection to surgical resection compared with the standard approach. Liquid-based ROSE had high concordance with final pathology. Total operative time, direct costs, and total costs were lower for the ROADAT procedure.

TCT-731 Setting the Stage: Comparative Analysis of Pulmonary Embolism Intervention in the Cath Lab Versus Operating Room

TCT-731 Setting the Stage: Comparative Analysis of Pulmonary Embolism Intervention in the Cath Lab Versus Operating Room

Treatment of Fracture Neck Femur with Biplane Double Screws Fixation Method in Elderly Patients

Abstract Background In active elderly patients with displaced femoral neck fractures, the total hip replacement is a golden standard. However, there are also patients with high operative risk for a large surgical intervention, defined by the presence of comorbidities and the arthroplasty procedure with these patients is contraindicated. Objective To assess the efficacy of Biplane double support screws in fixation of fracture neck of femur in elderly patients. Patients and Methods This was prospective study that was conducted in operative rooms of Ain Shams University Hospital, twenty one elderly patients with fracture neck of femur was treated using biplane double support screws fixation. Results Regarding garden classification of femur neck fracture, 47.6% of the patients were type 4. Regarding outcome, 10 patients were excellent, 6 patients were good, 3 patients were fair and 2 patients were poor. Mean ± SD of Union duration is 10.59 ± 1.46 weeks and only 2 cases (9.5%) complicated by Femoral head resorption. Conclusion In elderly and in those patients who cannot afford arthroplasty or in those patients where arthroplasty is contraindicated, BDSF method is an alternate method for fixing fracture neck of femur.

Prevention of Medical Device-Related Pressure Injury in The Operating Room: Nurses’ Knowledge and Training Imperatives

Prevention of Medical Device-Related Pressure Injury in The Operating Room: Nurses’ Knowledge and Training Imperatives

The Effect of Work Connectivity Behaviors on Work-Family Conflict among Operating Room Nurses - The Mediating Role of Psychological Disengagement

The Effect of Work Connectivity Behaviors on Work-Family Conflict among Operating Room Nurses - The Mediating Role of Psychological Disengagement

AI 기반 서비스디자인을 통한 수술실 간호사의 업무 환경 개선 및 다학제적 융합 연구

AI 기반 서비스디자인을 통한 수술실 간호사의 업무 환경 개선 및 다학제적 융합 연구

Intraoperative marking of pulmonary nodules in a hybrid operating room: electromagnetic navigation bronchoscopy versus percutaneous marking.

Intraoperative identification of subsolid or small pulmonary nodules during minimally invasive procedures is challenging. Recent localization techniques show varying success and complications. Hybrid operating rooms (HORs), equipped with radiological tools, facilitate intraoperative imaging. This study compares the accuracy and safety of marking pulmonary nodules using electromagnetic navigation bronchoscopy (ENB) combined with Cone Beam Computed Tomography (CBCT) vs. CBCT-guided percutaneous marking (PM). This retrospective cohort study included patients with pulmonary nodules scheduled for minimally invasive resection in a HOR. Marking techniques included ENB assisted by CBCT and PM guided by CBCT. The study compared the success rate, procedure time, intraoperative complications and radiation dose of both techniques. A total of 104 patients with 114 nodules were included (October 2021-July 2024). Thirty nodules were marked using ENB, and 84 with PM. One case used both techniques due to ENB failure. No differences among groups were found in nodule characteristics. Success rates were similar (93.3% in ENB group vs. 91.7% in PM group, p = 1). Marking took significantly longer time in the ENB group (median 40 min) compared to PM group (25 min, p = 0.007). Five (6%) patients in the PM group experienced intraoperative complications compared to none in the ENB (p = 0.323). Radiation dose was significantly higher in the ENB group (p = 0.002). ENB assisted by CBCT is a safe and effective technique, with success rates comparable to CBCT-guided PM, though it may result in longer procedural times and higher radiation doses.