Surgical Events Research Articles

Mortality and Function After Hip Fracture or Pneumonia in People With and Without Dementia.

The extent to which disruptive surgical or medical events impact mortality and function is critical for anticipatory planning and informing goal-aligned care. Using Health and Retirement Study data (2008-2018), we employed propensity score matching to compare the impact of hospitalization for hip fracture (a surgical event) or pneumonia (a medical event) among people with dementia to two groups: (1) people with dementia who did not experience these events; and (2) people without dementia who experienced an event. Dementia status was determined using validated cognitive assessments (Hurd method); hip fracture and pneumonia were identified from Medicare claims. Outcomes were 1-year mortality and function, defined as a summary score of requiring assistance with 6 ADL's and 5 IADL's, with higher scores indicating better function. Among people with dementia, predicted 1-year mortality was higher among those with hip fracture (35.4%) versus those without hip fracture (14.8%), with similar patterns for pneumonia (49.6% vs. 13.0%). Among people with dementia, function declined abruptly at time of hip fracture (-2.09 [95% CI -2.94, -1.25]) and continued to decline after (-0.48 [95% CI -0.87, -0.09]). There were similar patterns for pneumonia (drop at time of pneumonia of -1.49 [95% CI -2.0, -0.97] and after -0.05 [95% CI, -0.29, 0.19]). Compared to people without dementia with hip fracture, people with dementia had higher 1-year mortality (35.4%) versus people without dementia (24%), with similar patterns for pneumonia (49.6% vs. 39.7%). Function stabilized for people without dementia after hip fracture (-0.03, 95% CI -0.22, 0.16), which was significantly different than people without dementia (p < 0.0001). Function improved for people without dementia after pneumonia (0.13, 95% CI 0.03, 0.24), but was not statistically different than for people with dementia (p = 0.17). Disruptive events such as hip fracture or pneumonia substantially alter the clinical trajectories of people with dementia.

Rotational Stability and Outcomes of V4c Toric Implantable Collamer Lenses Placed at Different Lens Orientations.

To evaluate the 12-month rotational stability and outcomes of V4c toric Implantable Collamer Lenses (TICLs) (STAAR Surgical) located at two different lens orientations (horizontal or oblique). This retrospective study included a total of 403 eyes with TICL implantation, enrolled between January 2021 and December 2022, that were divided into two groups based on the minimum intended angle off the horizontal axis: horizontal with 263 eyes at an angle ±22.5 degrees or less and oblique with 140 eyes at a minimum intended angle of greater than ±22.5 degrees. A comparison was made of the preoperative characteristics, surgical outcomes, secondary surgical interventions, footplate positions, and adverse events at 1, 6, and 12 months postoperatively. The rotation-related factors were analyzed. At 12 months, there were 243 eyes (92%) in the horizontal group and 130 eyes (93%) in the oblique group that were within ±0.50 diopters (D) of emmetropia. Their rotation proportion was 5.3 % and 5.7%, respectively, and their rotation angle was 9.11 ± 2.84 and 9.96 ± 2.42 degrees, respectively (P = .086). TICL footplates were mostly positioned on the ciliary body. No correlation was observed of lens placement axis, vault, or manifest refraction with rotation in both groups (P > .05). During the follow-up, no vision-threatening complications were observed in both groups. Rotation cases were successfully addressed via alignment or lens exchange. TICLs, when implanted across a range of lens orientations, demonstrated favorable rotational stability and postoperative outcomes. The postoperative rotational stability is independent of the placement angle of the TICL. [J Refract Surg. 2025;41(1):e29-e38.].

A prospective study on the enhancement of surgical safety in robotic surgery: The BirdView camera system.

To investigate the surgical safety and benefits of using the BirdView camera system with a wide field of view in robotic surgery for rectal cancer in a prospective clinical study. This study included 20 consecutive patients who underwent robotic surgery at our institution between the years 2022 and 2023. The primary endpoint was perioperative safety, which was defined as the occurrence of adverse events, including other organ injuries and malfunctions, caused by the BirdView camera system. There were no injuries to any other organs caused by the console surgeon or assistant forceps during surgery. Surgical adverse events occurred in five cases (atelectasis, paralytic ileus, and anastomotic leakage) during the postoperative course. There were no cases of device failure or damage to the surrounding organs, including peritoneal heat damage. We believe that the BirdView system could be valuable in improving the safety of robotic surgery by enabling the observation of blind spots, thus preventing harm to other organs.

Integumentary and musculoskeletal indications for surgery predominate in a 15-year study of search-and-rescue dogs.

Analyze data from a 15-year longitudinal study of search-and-rescue (SAR) dogs to determine the indications for surgery and evaluate whether the risk varied by breed, sex, neutering, or deployment status during 9/11. 150 SAR dogs: 95 dogs deployed to sites from the September 11, 2001, terrorist attacks and 55 SAR dogs not deployed to these sites. Search-and-rescue dog handlers completed an annual health survey until the dog's death, or the handler withdrew from the study. The reported surgical events were categorized by body system and etiology. Incidence risk rates, with 95% CIs, were calculated for the most common surgical indications. Incidence rate ratios were calculated stratified by deployment status, sex, and breed, and significance was assessed. Over the study period, 103 surgical events were recorded in 67 of the 150 dogs (45%; 95% CI, 37% to 53%); 41 dogs had 1 event, 18 had 2 events, 6 had 3 events, and 2 had 4 events. Deployment status during 9/11, breed, sex, and neuter status were not significantly associated with the affected body system. The most affected body systems were the integumentary and musculoskeletal systems. The most common etiologies were trauma, neoplasia, inflammatory, and degenerative conditions. Search-and-rescue dogs experienced relatively routine or minor conditions despite the occupational hazards of their careers. Surgery will impact working dog health and performance. Preventive efforts to reduce and interventions to treat surgical conditions in SAR dogs should focus on the integumentary and musculoskeletal systems.

Use of SGLT2i Versus DPP-4i as an Add-On Therapy and the Risk of PAD-Related Surgical Events (Amputation, Stent Placement, or Vascular Surgery): A Cohort Study in Veterans With Diabetes

OBJECTIVE To compare the risk of composite peripheral artery disease (PAD) surgical outcome, including peripheral revascularization and amputation procedures, between new users of sodium–glucose cotransporter 2 inhibitors (SGLT2is) and dipeptidyl peptidase 4 inhibitors (DPP-4is). RESEARCH DESIGN AND METHODS This retrospective cohort study of U.S. veterans age ≥18 years with diabetes who received care from the Veterans Health Administration was performed from 1 October 2000 to 31 December 2021. Data were linked to Medicare, Medicaid, and the National Death Index. New use of SGLT2i or DPP-4i medications as an add-on to metformin, sulfonylurea, or insulin treatment alone or in combination was evaluated for an association with PAD surgical procedure for peripheral revascularization and amputation. A Cox proportional hazards model for time-to-PAD event analysis compared the risk of a PAD event between SGLT2is and DPP-4is in a propensity score–weighted cohort with a competing risk of death and allowance for events to occur up to 90 days or 360 days after stopping SGLT2is. RESULTS The weighted cohort included 76,072 SGLT2i vs. 75,833 DPP-4i use episodes. The median age was 69 years, HbA1c was 8.4% (interquartile range [IQR] 7.5–9.4%), and the median diabetes duration was 10.1 (IQR 6.6–14.6) years. There were 874 and 780 PAD events among SGLT2i and DPP-4i users, respectively, for an event rate of 11.2 (95% CI 10.5–11.9) and 10.0 (9.4–10.6) per 1,000 person-years (adjusted hazard ratio [aHR] 1.18 [95% CI 1.08–1.29]). When PAD events were allowed for 360 days after SGLT2i use ended, the aHR was 1.16 (95% CI 1.06–1.26). CONCLUSIONS SGLT2i as an add-on diabetes therapy was associated with an increased cause-specific hazard of PAD surgeries compared with DPP-4i.

Microvascular decompression in trigeminal neuralgia using a robot-assisted exoscope and head-mounted display.

Microvascular decompression (MVD) in trigeminal neuralgia (TN) is currently managed using an operating microscope (OM). Recent experiences with endoscopy-assisted, fully endoscopic, and exoscopic surgery have been described, aiming to improve ergonomics and image quality. The aim of this study was to report the first series of patients operated on with the aid of a robotic binocular exoscope using a head-mounted display (RoboticScope). From September 2023 to March 2024, 9 patients with TN were treated using the RoboticScope. A classic mini-retrosigmoid approach was performed and standard microsurgical techniques were applied. Surgical timing, ergonomics, visual performances, adverse events, and 1-month postoperative pain outcomes were evaluated. All surgeries were completed without shifting to the OM. Surgeon comfort with the RoboticScope was better compared with the OM and visualization was good. No intraoperative adverse events were recorded. The duration of the procedure was significantly shorter with the RoboticScope compared to those using the OM (median 18 vs 34 minutes, p = 0.0001). MVD can be safely and effectively performed using the RoboticScope. Surgeons benefit from better ergonomics, stereoscopic image quality, and shorter surgical duration.

Chlorhexidine-alcohol compared with povidone-iodine-alcohol skin antisepsis protocols in major cardiac surgery: a randomized clinical trial

PurposeWhether skin disinfection of the surgical site using chlorhexidine-alcohol is superior to povidone-iodine-alcohol in reducing reoperation and surgical site infection rates after major cardiac surgery remains unclear.MethodsCLEAN 2 was a multicenter, open-label, randomized, two-arm, assessor-blind, superiority trial conducted in eight French hospitals. We randomly assigned adult patients undergoing major heart or aortic surgery via sternotomy, with or without saphenous vein or radial artery harvesting, to have all surgical sites disinfected with either 2% chlorhexidine-alcohol or 5% povidone-iodine-alcohol. The primary outcome was any resternotomy by day 90 or any reoperation at the peripheral surgical site by day 30.ResultsOf 3242 patients (1621 in the chlorhexidine-alcohol group [median age, 69 years; 1276 (78.7%) men] and 1621 in the povidone-iodine-alcohol group [median age, 69 years; 1247 (76.9%) men], the percentage required reoperation within 90 days was similar (7.7% [125/1621] in the chlorhexidine-alcohol group vs 7.5% [121/1621] in the povidone-iodine-alcohol group; risk difference, 0.25 [95% confidence interval (CI), − 1.58–2.07], P = 0.79). The incidence of surgical site infections at the sternum or peripheral sites was similar (4% [65/1621] in the chlorhexidine-alcohol group vs 3.3% [53/1621] in the povidone-iodine-alcohol group; risk difference, 0.74 [95% CI − 0.55–2.03], P = 0.26). Length of hospital stay, intensive care unit or hospital readmission, mortality and surgical site adverse events were similar between the two groups.ConclusionAmong patients requiring sternotomy for major heart or aortic surgery, skin disinfection at the surgical site using chlorhexidine-alcohol was not superior to povidone-iodine-alcohol for reducing reoperation and surgical site infection rates.

Eliminating Error in Central Line Scheduling and Placement Using Quality Improvement Methods.

The Joint Commission defines a sentinel event as "surgery or other invasive procedure performed at the wrong site, on the wrong patient, or that is the wrong (unintended) procedure for a patient regardless of the type of procedure or the magnitude of the outcome." At our institution, we observed a low but consistent rate of incorrect surgical line placement for pediatric patients with cancer. Following quality improvement methodology and using the resources available on a large academic medical campus we designed and implemented a new multi-factorial process to schedule and place surgical central lines for pediatric patients with cancer. Changes included re-defining responsibilities, adding staff, and redesigning the process with workflows supported by modifications to the electronic medical record. Our primary outcome measures were incorrect central line placement or near miss event per quarter and days between these events. After implementation the rate of incorrect line placement and near miss events was reduced to zero with 1018 days since the last incorrect line placement. As a result of our multi-factorial quality improvement initiative in the scheduling and placement of central lines, we were able to eliminate surgical line placement sentinel events and improve care for pediatric patients with cancer.

Effects of dexamethasone combined with vitamin B12 on percutaneous endoscopic interlaminar discectomy early outcomes: a randomized controlled trial

BackgroundResidual low back and leg pain can occur after percutaneous endoscopic interlaminar discectomy (PEID) and compromise early surgical outcomes. This study aimed to determine the efficacy of combining dexamethasone with vitamin B12 (VB12) via epidural injection in improving the symptoms of low back and leg pain after PEID, and the underlying mechanism of action.MethodsPatients who underwent PEID for lumbar disc herniation (LDH) were enrolled and randomly assigned to the single surgery (SS) group, where disc removal was performed via PEID alone, or the combined treatment (CT) group, which received epidural injections of dexamethasone and VB12 alongside surgery. The outcome measures were the Visual Analog Scale (VAS), Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), serum inflammatory factor expression, adverse surgical events, duration of postoperative hospitalization, and modified MacNab criteria.ResultsCompared with the SS group, the CT group exhibited lower VAS scores for low back and leg pain at 1, 3, and 7 days post-surgery (P < 0.05). JOA and ODI scores were significantly improved in the CT group than in the SS group 7 days post-surgery (P < 0.05); however, no significant differences were observed at other time points. Serum inflammatory factors were lower in the CT group than in the SS group 3 days post-surgery (P < 0.05). The duration of postoperative hospitalization was shorter in the CT group (P < 0.05). Both groups had similar good outcomes (89.3% vs. 92.2%, P = 0.945).ConclusionsEpidural injection of dexamethasone and VB12 effectively reduces early postoperative low back and leg pain, lowers postoperative inflammatory factor expression, and improves early PEID outcomes. Its clinical adoption merits consideration.Trial registrationThis trial was registered with the China Clinical Trial Registration Center (Identifier: ChiCTR2400088854).

Revolutionizing spinal interventions: a systematic review of artificial intelligence technology applications in contemporary surgery

Leveraging its ability to handle large and complex datasets, artificial intelligence can uncover subtle patterns and correlations that human observation may overlook. This is particularly valuable for understanding the intricate dynamics of spinal surgery and its multifaceted impacts on patient prognosis. This review aims to delineate the role of artificial intelligence in spinal surgery. A search of the PubMed database from 1992 to 2023 was conducted using relevant English publications related to the application of artificial intelligence in spinal surgery. The search strategy involved a combination of the following keywords: "Artificial neural network," "deep learning," "artificial intelligence," "spinal," "musculoskeletal," "lumbar," "vertebra," "disc," "cervical," "cord," "stenosis," "procedure," "operation," "surgery," "preoperative," "postoperative," and "operative." A total of 1,182 articles were retrieved. After a careful evaluation of abstracts, 90 articles were found to meet the inclusion criteria for this review. Our review highlights various applications of artificial neural networks in spinal disease management, including (1) assessing surgical indications, (2) assisting in surgical procedures, (3) preoperatively predicting surgical outcomes, and (4) estimating the occurrence of various surgical complications and adverse events. By utilizing these technologies, surgical outcomes can be improved, ultimately enhancing the quality of life for patients.

Effect of Early-Intervention Acupuncture on Pain Relief Among Emergency Department Patients with Suspected Acute Renal Colic Due to Urinary Calculi: Study Protocol for a Randomized Clinical Trial.

Analgesia is often delayed for suspected acute renal colic due to urinary calculi (ARCUC) even in emergency department. Acupuncture has a rapid onset and is effective for analgesia, however, evidence about early-acupuncture for suspected ARCUC is limited. This trial aims to evaluate the efficacy of early-intervention acupuncture compared with sham acupuncture on pain relief among emergency department suspected ARCUC patients. A total of 84 eligible patients who are suspected diagnosed with ARCUC will be randomly allocated to the acupuncture group or the sham acupuncture group. Each patient will receive 1 session of acupuncture or sham acupuncture before diagnostic imaging. The primary outcome will be the response rate at 10min after needle manipulation, defined as the proportion of patients whose Numeric Rating Scale (NRS) score decrease by at least 50% from baseline. Secondary outcomes will include pain intensity assessed by NRS, further analgesia requirement, revisit rate, surgical intervention rate, satisfaction evaluation, and adverse events. The final diagnosis rate determined by radiography will be recorded and reported. All patients who receive randomization will be included in the intention-to-treat analysis. This study's findings are anticipated to evaluate the analgesic effect of early-intervention acupuncture for acute renal colic in emergency department, which could be useful for moving the timing of analgesia forward and aligning pain management for acute renal colic more with the guidelines. ChiCTR2100049069 (https://www.chictr.org.cn/showproj.html?proj=125338).

Initial Validation of the NOL Nociception Level Index® Monitoring System in Black and Multiracial People.

The NOL-Nociception Level Index® is a multiparameter index, based on artificial intelligence for the monitoring of nociception (physiological pain response) during anesthesia that has recently been authorized by the FDA. The monitor utilizes continuous streams of information from a finger probe comprising four sensors, including photoplethysmography, to provide a personalized nociception score on a scale of 0-100. Recent studies have suggested racial bias in pulse oximeter measurements due to the effect of melanin levels on photoplethysmography measurements. Therefore, there is a need to clinically validate new monitoring technologies in patients of all skin tones. The performance of the NOL scale in 8 patients that self-identified as Black or multiracial was compared to a database of 447 consented patients, assessing the response to surgical events at different levels of intensity. The descriptive, pilot data suggest that NOL performance in Black and multiracial patients is not different from the performance shown for the large database. Larger studies utilizing recognized skin tone scales to ensure accurate assessment of skin pigmentation are planned for the future.

Experience of Hyperbaric Chamber Usage in Aesthetic Plastic Surgery Practice for Recovery and Complication Prevention.

Hyperbaric oxygen therapy (HBOT) increases oxygen concentration in affected tissues that enhance the cellular hypoxia recovery process, neovascularization, fibroblast proliferation, increased reactive oxygen species, suppression of proinflammatory states, and vascular compression. The aim of this article is to demonstrate the experience in the use of the hyperbaric chamber as an adjunctive management for the prompt recovery of patients who underwent aesthetic plastic surgery. A retrospective descriptive study was conducted between 2021 and 2023, involving 296 patients who received HBOT after aesthetic surgical procedures, to demonstrate the recuperation time rate and the complication incidence in postoperative patients using HBOT. Most participants were women, with a median age of 33.5 years. Surgical procedures were grouped in liposculpture, abdominoplasty, and breast interventions. Complications related to the surgical event were low (10.7%), with occurrences of hematomas (n = 14, 4.72%), anemias (n = 9, 3.04%), and wound dehiscence (n = 8, 2.70%). There were no reports of surgical site infections or necrosis. Recovery times to get back to work were 10 days for liposuction, 3 days for breast interventions, and 21 days for abdominoplasty. This study demonstrated the experience of using a postoperative hyperbaric chamber in aesthetic plastic surgery to promote recovery processes. The patient cohort in this study showed shortened recovery times than the data obtained from the major international plastic surgery organizations. Also, HBOT patients had a low complication rate, without infections, indicating the potential efficacy of this adjunctive therapy. Overall, this study underscores the promising role of hyperbaric chamber therapy in facilitating postoperative recovery and mitigating complications.

The Effect and Long-term Prognosis of Different Suturing Methods for Meniscus Repair Under Knee Arthroscopy.

This study aims to evaluate the efficacy and long-term prognosis of all-inside and outside-in suturing methods for meniscus repair under knee arthroscopy. A retrospective analysis was conducted on 120 patients with meniscus injuries who underwent surgical treatment at Yuhuan People's Hospital, Department of Joint Surgery, from January 2019 to March 2021. Based on the suturing method, patients were assigned into two groups: Group A (64 cases, all-inside suturing) and Group B (56 cases, outside-in suturing). Surgical indicators and adverse events were recorded for both cohorts. The variances in proprioception before and after surgery, International Knee Documentation Committee (IKDC) scores, Lysholm scores, knee range of motion (ROM), and Visual Analogue Scale (VAS) pain scores were compared between the two groups. Group A had significantly shorter operative time, postoperative immobilization, and hospital stay compared to Group B (p < 0.05). The overall incidence of adverse events was 12.50% in Group A and 16.07% in Group B, with no significant difference between the groups (p > 0.05). There were no substantial differences in preoperative knee proprioception difference values, IKDC scores, Lysholm scores, VAS scores, and knee ROM between the two groups (p > 0.05). At three months postoperatively, Group A exhibited lower proprioception difference values at 15°C, 45°C, and 75°C angles compared to Group B (p < 0.05). Additionally, at three months and three years postoperatively, Group A showed higher IKDC scores, Lysholm scores, and ROM and lower VAS scores compared to Group B (p < 0.05). Compared to the outside-in suturing approach, the all-inside suturing method for treating meniscus damage is more effective. It attenuates operative time, postoperative immobilization time, and hospital stay, ameliorates knee proprioception, promotes knee function recovery, alleviates pain, and is safe and reliable.

Morbidity related to major lung thoracoscopic resections in children.

In pediatric thoracic surgery, reported predictors for increased risk are symptoms and active/previous infections (RAP). We investigated the adverse events related to Video-Assisted Thoracic Surgery (VATS) in pediatric patients when considering RAP predictors. A retrospective analysis of pediatric VATS major lung resections in 2008-2021 was conducted at three institutions. We employed the pediatric surgical risk calculator to define patients' preoperative predicted risk (PredR). Postoperative complications were classified according to the Thoracic Morbidity & Mortality (TM&M) system. The observed TM&M rate (ObsR) and the PredR were compared. A subgroup analysis by RAP predictors was conducted. 37 patients (54% female) were included. Mean age and weight were 5.8 years and 22.8 kg. 56.7% had respiratory symptoms, 38.9% active infection and 59.5% history of infections (RAP subpopulations). VATS procedures were lobectomy (n=32), segmentectomy (n=3), bilobectomy (n=1) and pneumonectomy (n=1). The conversion rate was 5.4%. The mean PredR was of 4.43% (±1.8) and the overall ObsR was 45.94% with a median severity of II (I-III). This difference was significant and a higher PredR was not associated with complications development. PredR does not show association among the RAP vs non-RAP group. ObsR showed positive association with RAP, even if it reached statistical significance only for "respiratory symptoms" risk factor. ObsR reflected the number of bronchiectasis patients in our series (n=9), aligning with the hypothesis of "earlier and safer surgery". The risk calculator underestimates VATS morbidity. Multicentre studies will clarify the correlation between inflammation and surgical adverse events.

Evaluation of preoperative intraperitoneal injection of bupivacaine for intraoperative antinociception in cats undergoing ovariohysterectomy: A randomized clinical trial

ObjectiveTo determine if preoperative intraperitoneal bupivacaine can minimize intra- and postoperative nociception/pain in cats undergoing ovariohysterectomy. Study designProspective, randomized, investigator-blinded, placebo-controlled clinical trial. AnimalsForty-seven, intact female cats. MethodsCats were anesthetized using a standard protocol and randomized to receive ultrasound-guided intraperitoneal 0.9 % saline (US-S) or 0.25 % bupivacaine (US-IPLA) before ovariohysterectomy. On recovery, US-S cats received 2 mg/kg robenacoxib subcutaneously and US-IPLA cats received equivalent volume of 0.9 % saline subcutaneously. Intraoperative outcome variables included heart rate (HR), respiratory rate (fR), systolic arterial pressure (SAP), and vaporizer setting associated with relevant surgical events characterized by manipulation of each ovarian pedicle (OP1, OP2) and the uterine body (UB). The postoperative outcome variable was need for rescue analgesia, determined using the Glasgow Composite Measure Pain Scale during 6 h after tracheal extubation. Intraoperative data were analyzed using two-way ANOVA and Šidák's multiple comparisons test. The probability of postoperative rescue analgesia was analyzed using the Gehan–Breslow–Wilcoxon test. Significance was p < 0.05. ResultsCompared to baseline, all surgical events caused significant increases in HR and SAP in both groups, fR increased in US-IPLA but not in US-S, vaporizer settings remained unchanged during OP1, OP2 and UB in group US-IPLA, and were significantly higher only during OP1 in group US-S. There were no significant between-group differences in intraoperative variables and postoperative need for rescue analgesia. Conclusions and clinical relevancePreoperative intraperitoneal bupivacaine had minimal effects on intraoperative indicators of nociception. The need for rescue analgesia was not significantly different between groups.

Application of Information Link Control in Surgical Specimen Near-Miss Events in a South China Hospital: Nonrandomized Controlled Study.

Information control is a promising approach for managing surgical specimens. However, there is limited research evidence on surgical near misses. This is particularly true in the closed loop of information control for each link. A new model of surgical specimen process management is further constructed, and a safe operating room nursing practice environment is created by intercepting specimen near-miss events through information safety barriers. In a large hospital in China, 84,289 surgical specimens collected in the conventional information specimen management mode from January to December 2021 were selected as the control group, and 99,998 surgical specimens collected in the information safety barrier control surgical specimen management mode from January to December 2022 were selected as the improvement group. The incidence of near misses, the qualified rate of pathological specimen fixation, and the average time required for specimen fixation were compared under the 2 management modes. The causes of 2 groups of near misses were analyzed and the near misses of information safety barrier control surgical specimens were studied. Under the information-based safety barrier control surgical specimen management model, the incidence of adverse events in surgical specimens was reduced, the reporting of near-miss events in surgical specimens was improved by 100%, the quality control quality management of surgical specimens was effectively improved, the pass rate of surgical pathology specimen fixation was improved, and the meantime for surgical specimen fixation was shortened, with differences considered statistically significant at P<.05. Our research has developed a new mode of managing the surgical specimen process. This mode can prevent errors in approaching specimens by implementing information security barriers, thereby enhancing the quality of specimen management, ensuring the safety of medical procedures, and improving the quality of hospital services.

Utilizing a surgical sabermetrics framework to evaluate the impact of simulated operative crises on trainee cognitive load and non-technical skills

Abstract Intraoperative crisis events, such as haemorrhage or iatrogenic perforation, can cause considerable stress in the operating surgeon. Little standardized training exists for managing such events, especially for surgical trainees. Cognitive load (CogL) is the extent to which a task places demands on cognitive resources. Such resources are finite, and when overwhelmed, can lead to stress, which in turn can negatively affect intraoperative technical and non-technical performance. Surgical sabermetrics is a novel field that involves advanced analysis of data obtained from non-invasive physiological sensors measuring surgeon CogL, as well as audiovisual recordings of surgical procedures capturing surgeon technical and non-technical skills. This data-driven approach enhances understanding of factors that can improve, or worsen, surgical performance. ‘Managing Surgical Crises’ is a high-fidelity simulation course which exposes surgical trainees to standardized intraoperative crises with no risk to patient safety. This study aims to apply a sabermetrics framework to the ‘Managing Surgical Crises’ course to gain insight into trainee surgeon CogL and non-technical skills during the introduction and response to crisis events. Surgical trainees will be allocated to a simulated surgical crisis event and tasked with managing the scenario utilizing the Team, Environment, Assess/Analyse/Anticipate, Manage resources (TEAM) algorithm. A sabermetrics framework will be employed to collect quantitative data regarding CogL and non-technical performance. Full ethical approval has been obtained for this study. Dissemination of the results will be through conferences and publications in peer-reviewed journals.

Efficacy and safety of vancomycin for local application in the prevention of surgical site infection after joint arthroplasty: a systematic review and meta-analysis.

The aim of this systematic review and meta-analysis is to explore the effect of topical vancomycin powder (VP) in surgical site infection (SSI) prevention and adverse events after joint arthroplasty and to provide a specific theoretical basis for clinical treatment. The review process was conducted according to the PRISMA guidelines. Two independent researchers meticulously screened the literature based on predefined inclusion and exclusion criteria, evaluated the quality of the selected studies, and extracted relevant data. Data analysis was conducted using RevMan 5.4 software. This meta-analysis included 24 studies encompassing a total of 34 811 patients. The pooled analysis showed that the topical administration of VP significantly reduced the incidence of SSI. Subgroup analyses by doses, type of joint (hip and knee), and type of surgery (primary and revision) confirmed that vancomycin consistently lowered SSI rates. Moreover, the incidence of SSI caused by gram-negative germs and gram-positive germs decreased following the use of VP, although the reduction was not significant for infections caused by MRSA. However, the use of VP was associated with a significant increase in sterile complications at the incision site and delayed incision healing. The topical application of VP is effective in reducing the incidence of infections following joint arthroplasty. Despite an increased risk of complications such as delayed healing of incisions, the pros and cons should be weighed in clinical decision-making. However, it should not be discarded due to side effects.

Comparison of spinal anesthesia and local anesthesia in percutaneous interlaminar endoscopic lumbar discectomy for L5/S1 disc herniation: a retrospective cohort study

BackgroundInterlaminar endoscopic lumbar discectomy (IELD) is a prevalent method for managing lumbar disc herniation. Local anesthesia (LA) is frequently employed during IELD, albeit with its merits and drawbacks. The spinal anesthesia (SA) represents a feasible anesthetic strategy for IELD; however, the availability of clinical research data is currently limited.MethodsThe propensity score matching was conducted to ensure the comparability of the SA and LA groups. The outcome measures were operation time, intraoperative visual analogue scale (VAS) for pain, need for adjuvant analgesia, intraoperative vital signs, blood loss, adverse surgical events, anesthesia-related complications, postoperative bed rest duration, VAS for pain at 2 h postoperatively, Oswestry Disability Index score (ODI), satisfaction with surgical efficacy, and willingness to undergo reoperation at 6 months postoperatively.ResultsFifty-six patients were assigned to each group. Significant differences were found between the groups regarding intraoperative VAS for pain, use of adjuvant analgesics, willingness to undergo reoperation, maximum intraoperative systolic blood pressure, and variability (P < 0.05). Compared to the LA group, the SA group had lower VAS for pain at 2 h postoperatively, a longer operation time, a longer duration of postoperative bedrest, and more anesthesia-related complications (P < 0.05). No significant intergroup differences were detected in intraoperative heart rate variability, blood loss, ODI, satisfaction with surgical efficacy, and surgery-related complications (P > 0.05).ConclusionSA as an alternative anesthesia for IELD surgery holds great promise, exhibiting superior efficacy compared to LA. However, it is crucial to meticulously evaluate the indications due to potential risks associated with this form of anesthesia.