Preoperative Site Marking Research Articles

Clinical Issues-August 2022.

Use of sterile vests Key words: sterile technique, surgical attire, gown, contaminated, back. Bare arms for unscrubbed personnel Key words: long sleeves, cover jacket, disposable jacket, patient skin antisepsis, surgical site infection (SSI). Preventing thermal injury from electrosurgical devices Key words: electrosurgical unit (ESU), monopolar electrosurgical device, electrode, alternate site thermal injury, burn. Preoperative site marking for minimally invasive procedures Key words: surgical site, wrong-site surgery, alternative site marking, point of access, preprocedure verification.

The effect of preoperative stoma site marking on risk of stoma‐related complications in patients with intestinal ostomy — A systematic review and meta‐analysis

This systematic review and meta-analysis aimed to investigate the effect of preoperative stoma site marking on stoma-related complications in patients with intestinal ostomy. MEDLINE, Embase, CENTRAL, CINHAL, and Google Scholar were searched up to August 2021 for randomised controlled trials (RCTs) and nonrandomised studies of interventions (NRSI) that involved patients with intestinal ostomies comparing preoperative stoma site marking to no marking and which reported at least one patient-relevant outcome. Outcomes were prioritised by stakeholder involvement. Random-effects meta-analyses produced odds ratios (ORs) or standardised mean differences (SMD) and 95% confidence intervals (CIs). The ROBINS-I tool and the GRADE approach were used to assess the risk of bias and certainty of evidence, respectively. This review included two RCTs and 25 NRSI. The risk of bias was high in RCTs and serious to critical in NRSI. Although preoperative site marking reduced stoma-related complications (OR: 0.45, 95% CI: [0.31-0.65]), dependence on professional or unprofessional care (narrative synthesis), and increased health-related quality of life (SMD: 1.13 [0.38-1.88]), the evidence is very uncertain. Preoperative site marking may probably reduce leakage (OR: 0.14 [0.06-0.37]) and may decrease dermatological complications (OR: 0.38 [0.29-0.50]) and surgical revision (OR: 0.09 [0.02-0.49]). The confidence in the cumulative evidence was moderate to very low. Despite low quality evidence, preoperative stoma site marking can prevent stoma-related complications and should be performed in patients undergoing gastrointestinal surgery given that this intervention poses no harm to patients.

Usefulness of preoperative site marking with an indocyanine green fluorescent clip for gastrointestinal stromal tumor.

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Late complications in patients with intestinal ostomies who underwent a preoperative site marking

Objectives: Describe late complications related to intestinal ostomies in patients undergoing a preoperative site marking. Method: Descriptive study with a quantitative approach. The convenience sample and was composed of 15 people with intestinal ostomies who underwent a preoperative site marking. Data collection was performed between January and March 2014 through a pre-established script that guided the physical examination and a questionnaire containing 13 questions related to the sociodemographic profile, diagnosis, and preoperative site marking. Results: It was verified that in 13 (87.7%) people who had site marked ostomies, it was located at a distance of more than 5 cm of surgical scars, iliac crest, umbilical scar, and waistline. Two people with ileostomy (13.3%) had intestinal loop protrusion short of recommended. Regarding postoperative complications, three participants (20%) presented peristomal dermatitis and one (6.7%), in addition to dermatitis, prolapse of the ostomy. Conclusion: The study showed that the postoperative complications reported by patients who underwent a preoperative stomatal site marking were poorly observed and that these was consisted of peristomal dermatitis and prolapse of the ostomy.

Preoperative Site Marking in Dermatosurgery.

Dermatosurgery is a growing subspeciality due to increasing numbers of skin cancer and aesthetic procedures. Patient safety is a major issue in dermatosurgery. Quality management, education, and organization are the backbone of patient safety. A simple measure to support patient’s safety and to avoid wrong site surgery is preoperative skin marking. Permanent skin markers offer a painless and cost-effective option. To ensure optimal results, the following problems need careful consideration: good viability after disinfection, sterility of the operation field, no sensitization, or toxic effects of the ink. These issues are discussed in detail to allow a safe and successful procedure.

Preoperative Site Marking: Are We Adhering to Good Surgical Practice?

Wrong-site surgery is a never event and a serious, preventable patient safety incident. Within the United Kingdom, national guidance has been issued to minimize the risk of such events. The mandate includes preoperative marking of all surgical patients. This study aimed to quantify regional variation in practice within general surgery and opinions of the surgeons, to help guide the formulation and implementation of a regional general surgery preoperative marking protocol. A SurveyMonkey questionnaire was designed and distributed to 120 surgeons within the Mersey region, United Kingdom. This included all surgical trainees in Mersey (47 registrars, 56 core trainees), 15 consultants, and 2 surgical care practitioners. This sought to ascertain their routine practice and how they would choose to mark for 12 index procedures in general surgery, if mandated to do so. A total of 72 responses (60%) were obtained to the SurveyMonkey questionnaire. Only 26 (36.1%) said that they routinely marked all of their patients preoperatively. The operating surgeon marked the patient in 69% of responses, with the remainder delegating this task. Markings were visible after draping in only 55.6% of marked cases. Based on our findings, surgeons may not be adhering to "Good Surgical Practice"; practice is widely variable and surgeons are largely opposed and resistant to marking patients unless laterality is involved. We suggest that all surgeons need to be actively engaged in the design of local marking protocols to gain support, change practice, and reduce errors.

A prospective audit of early stoma complications in colorectal cancer treatment throughout the Greater Manchester and Cheshire colorectal cancer network

The study aimed to identify the incidence of early stoma problems after surgery for colorectal cancer to identify predisposing factors and to assess the effect on discharge from hospital and the greater need for community stoma care. A prospective study of 192 patients was carried out over a six-month period in the 13 units of the Greater Manchester and Cheshire Cancer Network. Stoma problems were categorized into fistula, leakage, pancaking, necrosis, retraction, separation, stenosis, skin problems, parastomal hernia, suboptimal stoma site and need for resiting or refashioning. Differences in incidence between units (anonymized) were analysed, and the effect of stoma complications on length of hospital stay and the need for additional community stoma care was determined. One hundred and ninety-two patients with stomas were included, of which 52 (27.1%) were identified as being problematic (range 0-66.7% between units). Significant risk factors included stoma type (colostomy) (P < 0.05), short stoma length (P = 0.006), higher BMI (P = 0.043), emergency surgery (P = 0.002) and lack of preoperative site marking (P < 0.001). Problematic stomas were associated with longer hospital stay (P < 0.001) and increased community care (P < 0.001). Stoma type, stoma length, body mass index, emergency surgery and lack of preoperative marking were significant risk factors. Overall complication rates compare favourably with other studies.

Preoperative site marking

It is with great interest that we noted the comments on correct site surgery and preoperative site marking.1 In our own experience, we have recently encountered two episodes of sub-Tenon’s...

Sterility of the Surgical Site Marking Between the Ink and the Epidermis

To prevent wrong-site surgery, multiple organizations have endorsed the practice of signing the operative site with an indelible marker. Potential contamination of the surgical field and the inability to prepare the area under the ink film raises concerns. The purpose of this study was to determine if the use of preoperative site marking affects the sterility of the surgical field. After institutional review board approval, 30 consecutive patients scheduled to undergo elective upper extremity surgery by the same surgeon were included. For each patient, surgical marking according to Joint Commission on Accreditation of Healthcare Organizations guidelines were placed on more than half of the planned incision site, and the other half was left unmarked. The patients then underwent routine surgical preparation. The skin was incised, starting from the unmarked side and continuing to the marked aspect. Cultures were obtained by swabbing the skin edges: one from the unmarked side and one from the marked side. After blood agar plating, cultures were incubated for 72 hours and analyzed by a blinded observer. All cultures were negative, regardless of swab site (unmarked or marked location). The practice of surgical site marking does not increase the risk of operative field contamination.