Surgical Items Research Articles

Design and Early Evaluation of a Device to Improve the Sharp Count Process in Operating Rooms.

Counting surgical sharps in surgeries mitigates the risk of retained surgical items in patients. Current procedures rely on manual counts throughout and at the end of each surgery. The manual count is lengthy, burdensome, and carries the risk of injuries. This paper presents the design and early evaluation of a technology aid to automatize the sharps' counting process; it is composed of a shell holding a set of optical sensors that count needles that pass through the shell's top slot. The device was tested with needles originating from 20 surgeries. Users surveyed reported a decrease in counting time and perceived injury risk. The average count error was 4.4%, indicating the need to continue advancing the technology. The counting technology needs to be refined to increase accuracy, and a user guide for the equipment must be prepared. Thereafter, a new set of trials must be performed. Our work provides a detailed requirements list for developing a technology aid to improve the needle count process and investigates one possible technological route to address this problem.

Reducing Disposable Surgical Items: Decreasing Environmental Impact and Costs at a Children's Hospital, a Pilot Study

IntroductionUnited States landfill waste generated in the operating room (OR) is estimated to be three billion tons per year. The goal of this study was to analyze the environmental and fiscal impact of right-sizing surgical supplies at a medium-sized children's hospital using lean methodology to reduce physical waste generated in the operating room. MethodsA multidisciplinary task force was created to reduce waste in the OR of an academic children's hospital. A single-center case study, proof-of-concept, and scalability analysis of operative waste reduction was performed. Surgical packs were identified as a target. Pack utilization was monitored during an initial pilot analysis for 12 d then followed by a focused 3-week period, capturing all unused items by participating surgical services. Items discarded in more than 85% of cases were excluded in subsequent preformed packs. ResultsPilot review identified 46 items in 113 procedures for removal from surgical packs. Subsequent 3-week analysis focusing on two surgical services, and 359 procedures identified a potential $1,111.88 savings with elimination of minimally used items. Over 1 y, removal of all minimally used items from seven surgical services diverted two tons of plastic landfill waste, saved $27,503 in surgical pack acquisition-costs, and prevented the theoretical loss of $13,824 in wasted supplies. Additional purchasing analysis has resulted in another $70,000 of savings through supply chain streamlining. Application of this process nationally could prevent >6000 tons of waste in the United States per year. ConclusionsApplication of a simple iterative process to reduce waste in the OR can result in substantial waste diversion and cost savings. Broad adoption of such a process to reduce OR waste could greatly reduce the environmental impact of surgical care.

Quality of therapy in early ovarian cancer: results of the quality assurance program of the AGO Study Group

ObjectiveThe quality assurance program for ovarian cancer (QS-OVAR) evaluates the implementation of treatment standards and impact on survival for International Federation of Gynecology and Obstetrics (FIGO) stage I ovarian cancer.MethodsPatients...

Risk factors and prediction model for inpatient surgical site infection after elective abdominal surgery.

Surgical site infections (SSIs) are the commonest healthcare-associated infection. In addition to increasing mortality, it also lengthens the hospital stay and raises healthcare expenses. SSIs are challenging to predict, with most models having poor predictability. Therefore, we developed a prediction model for SSI after elective abdominal surgery by identifying risk factors. To analyse the data on inpatients undergoing elective abdominal surgery to identify risk factors and develop predictive models that will help clinicians assess patients preoperatively. We retrospectively analysed the inpatient records of Shaanxi Provincial People's Hospital from January 1, 2018 to January 1, 2021. We included the demographic data of the patients and their haematological test results in our analysis. The attending physicians provided the Nutritional Risk Screening 2002 (NRS 2002) scores. The surgeons and anaesthesiologists manually calculated the National Nosocomial Infections Surveillance (NNIS) scores. Inpatient SSI risk factors were evaluated using univariate analysis and multivariate logistic regression. Nomograms were used in the predictive models. The receiver operating characteristic and area under the curve values were used to measure the specificity and accuracy of the model. A total of 3018 patients met the inclusion criteria. The surgical sites included the uterus (42.2%), the liver (27.6%), the gastrointestinal tract (19.1%), the appendix (5.9%), the kidney (3.7%), and the groin area (1.4%). SSI occurred in 5% of the patients (n = 150). The risk factors associated with SSI were as follows: Age; gender; marital status; place of residence; history of diabetes; surgical season; surgical site; NRS 2002 score; preoperative white blood cell, procalcitonin (PCT), albumin, and low-density lipoprotein cholesterol (LDL) levels; preoperative antibiotic use; anaesthesia method; incision grade; NNIS score; intraoperative blood loss; intraoperative drainage tube placement; surgical operation items. Multivariate logistic regression revealed the following independent risk factors: A history of diabetes [odds ratio (OR) = 5.698, 95% confidence interval (CI): 3.305-9.825, P = 0.001], antibiotic use (OR = 14.977, 95%CI: 2.865-78.299, P = 0.001), an NRS 2002 score of ≥ 3 (OR = 2.426, 95%CI: 1.199-4.909, P = 0.014), general anaesthesia (OR = 3.334, 95%CI: 1.134-9.806, P = 0.029), an NNIS score of ≥ 2 (OR = 2.362, 95%CI: 1.019-5.476, P = 0.045), PCT ≥ 0.05 μg/L (OR = 1.687, 95%CI: 1.056-2.695, P = 0.029), LDL < 3.37 mmol/L (OR = 1.719, 95%CI: 1.039-2.842, P = 0.035), intraoperative blood loss ≥ 200 mL (OR = 29.026, 95%CI: 13.751-61.266, P < 0.001), surgical season (P < 0.05), surgical site (P < 0.05), and incision grade I or III (P < 0.05). The overall area under the receiver operating characteristic curve of the predictive model was 0.926, which is significantly higher than the NNIS score (0.662). The patient's condition and haematological test indicators form the bases of our prediction model. It is a novel, efficient, and highly accurate predictive model for preventing postoperative SSI, thereby improving the prognosis in patients undergoing abdominal surgery.

Clinical Issues - April 2023.

Flying insects in the OR Keywords: fly, pest control, infestation, surgical wound classification, sterile field. Reprocessing and reusing single-use devices Keywords: US Food and Drug Administration (FDA), reprocessing, manufacturer, single-use devices (SUDs), adverse event. Using instrument-marking tape Keywords: instrument tape, sterile processing, manufacturer's instructions for use (IFU), inspection, unintentionally retained surgical item. Epinephrine in orthopedic irrigation Keywords: epinephrine, irrigation, vasoconstrictor, arthroscopic procedures, visual field.

The impact of quality improvement interventions on compliance with standardised surgical count protocol and count discrepancies: A quality improvement study

Background: Unintentionally retained surgical items (RSI) are a global problem contributing to adverse events for surgical patients. The Association of periOperative Registered Nurses (AORN) has developed a standardised protocol for the surgical count; however, many hospitals do not follow the protocol for the surgical count. This study was conducted to investigate the effect of implementing quality improvement interventions, for counting surgical sponges, on compliance with the AORN surgical count protocol and occurrence of count discrepancies.

Relationship between medical programme progress test performance and surgical clinical attachment timing and performance

Purpose Progress tests (PTs) assess applied knowledge, promote knowledge integration, and facilitate retention. Clinical attachments catalyse learning through an appropriate learning context. The relationship between PT results and clinical attachment sequence and performance are under-explored. Aims: (1) Determine the effect of Year 4 general surgical attachment (GSA) completion and sequence on overall PT performance, and for surgically coded items; (2) Determine the association between PT results in the first 2 years and GSA assessment outcomes. Materials and methods All students enrolled in the medical programme, who started Year 2 between January 2013 and January 2016, were included; with follow up until December 2018. A linear mixed model was applied to study the effect of undertaking a GSA on subsequent PT results. Logistic regressions were used to explore the effect of past PT performance on the likelihood of a student receiving a distinction grade in the GSA. Results 965 students were included, representing 2191 PT items (363 surgical items). Sequenced exposure to the GSA in Year 4 was associated with increased performance on surgically coded PT items, but not overall performance on the PT, with the difference decreasing over the year. PT performance in Years 2–3 was associated with an increased likelihood of being awarded a GSA distinction grade (OR 1.62, p < 0.001), with overall PT performance a better predictor than performance on surgically coded items. Conclusions Exposure to a surgical attachment improves PT results in surgically coded PT items, although with a diminishing effect over time, implying clinical exposure may accelerate subject specific learning. Timing of the GSA did not influence end of year performance in the PT. There is some evidence that students who perform well on PTs in preclinical years are more likely to receive a distinction grade in a surgical attachment than those with lower PT scores.

Preventing Unintentionally Retained Surgical Items.

Preventing Unintentionally Retained Surgical Items.

Practices to Aid in the Prevention of Unintentionally Retained Surgical Items.

AORN JournalVolume 117, Issue 3 p. P11-P13 Lead Feature Practices to Aid in the Prevention of Unintentionally Retained Surgical Items Lisa Croke, Lisa Croke Managing EditorSearch for more papers by this author Lisa Croke, Lisa Croke Managing EditorSearch for more papers by this author First published: 24 February 2023 https://doi.org/10.1002/aorn.13890Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume117, Issue3March 2023Pages P11-P13 RelatedInformation

Committing to Prevent Unintentionally Retained Surgical Items.

AORN JournalVolume 117, Issue 2 p. P11-P11 Did You Know? Committing to Prevent Unintentionally Retained Surgical Items First published: 27 January 2023 https://doi.org/10.1002/aorn.13877Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume117, Issue2February 2023Pages P11-P11 RelatedInformation

Modification of Polyvinyl Chloride Composites for Radiographic Detection of Polyvinyl Chloride Retained Surgical Items.

The ever-present risk of surgical items being retained represents a real medical peril for the patient and potential liability issues for medical staff. Radiofrequency scanning technology is a very good means to substantially reduce such accidents. Radiolucent medical-grade polyvinyl chloride (PVC) used for the production of medical items is filled with radiopaque agents to enable X-ray visibility. The present study proves the suitability of bismuth oxychloride (BiOCl) and documents its advantages over the classical radiopaque agent barium sulfate (BaSO4). An addition of BiOCl exhibits excellent chemical and physical stability (no leaching, thermo-mechanical properties) and good dispersibility within the PVC matrix. As documented, using half the quantity of BiOCl compared to BaSO4 will provide a very good result. The conclusions are based on the methods of rotational rheometry, scanning electron microscopy, dynamic mechanical analysis, atomic absorption spectroscopy, and the verification of zero leaching of BiOCl out of a PVC matrix. X-ray images of the studied materials are presented, and an optimal concentration of BiOCl is evaluated.

A Multicenter Collaborative Effort to Reduce Preventable Patient Harm Due to Retained Surgical Items.

Unintentional retention of surgical items is severe but preventable patient harm in surgical procedures. One multicenter health care organization experienced a harm event due to retained surgical items (RSIs) every eight days in 2019-2020. The research team sought to reduce the incidence of harm due to RSIs, improve near-miss reporting, and increase process reliability in operating rooms across the organization. A total of 114 health care facilities in the organization were invited to participate in a multistate, multicenter patient safety initiative to reduce patient harm caused by RSIs. A national-level workgroup comprising various disciplines proposed an evidence-based best practice bundle with five elements: surgical stop, surgical debrief, visual counter, imaging, and reporting of deviations. The workgroup ensured that extensive education and support were accessible to all the participating sites. The researchers monitored the process reliability of bundle elements and improvement milestones of all the sites, along with rates of harm related to RSIs. Implementing the evidence-based RSI reduction bundle across 114 health care facilities resulted in a 14.3% reduction in the rate of harm caused by RSIs and a 59.1% increase in RSI near-miss reporting. The compliance to the RSI bundle reached an average of 70.5%, and 63.2% of the facilities are actively performing Plan-Do-Check-Act (PDCA) cycles to improve bundle compliance continually. Implementation of an RSI bundle can be done reliably, can improve near-miss reporting, and can reduce patient harm. Variation in process reliability between centers suggests the significance of overcoming cultural and organizational barriers.

Clinical Spectrum of Gossypiboma: Case Series and Review of Literature

Gossypiboma is a term used to describe retained surgical sponge after surgery. This is an avoidable clinical condition causing significant morbidity and mortality. The clinical presentation is variable and often a diagnostic enigma. The consequences of gossypiboma are undesirable, disappointing, and have medicolegal implications for the surgical team. We report three cases of gossypiboma with varying clinical spectrums. The first case had gastric outlet obstruction due to retained surgical sponge after open cholecystectomy. It had eroded both into the first part of the duodenum and transverse colon. Endoscopic and radiological evaluation helped to establish the diagnosis of duodenocolic fistula with gastric outlet obstruction. The second patient was treated for penetrating abdominal wound and presented with persistent fever with discharging sinus at the wound site. The third patient had undergone exploratory laparotomy for recurrent hydatid cyst of the liver and, in addition to recurrent hydatid cyst, a surgical sponge was also found. All these patients had retained surgical sponges but different clinical presentations. These patients underwent exploratory laparotomy and surgical removal of the retained surgical item (RSI) followed by a successful recovery. Gossypiboma should be considered as a differential diagnosis in all unexplained postoperative sepsis, intestinal obstruction, and intra-abdominal mass. Standard surgical safety measures in the operative room help to prevent the incidence of RSIs.

Surgical items retained in the abdominal cavity in diagnostic imaging tests: a series of 10 cases and literature review.

Despite improvements in the safety of surgical procedures, leaving a foreign object in a patient's body is still one of the complications of surgical procedures. The literature lacks an analysis of the effectiveness of specific diagnostic tests in detecting foreign objects. The authors present a discussion of the effectiveness of selected techniques and examples of the appearance of foreign bodies in radiological images based on the description of 10 cases. Leaving surgical haemostatic material in the abdominal or pelvic cavity is an underestimated phenomenon that poses a serious diagnostic problem. Computed tomography is the most sensitive method for detecting a foreign body, while a chest or abdominal X-ray is the simplest and most effective way to identify the surgical material. Ultrasound, although widely available, has not shown utility in diagnosing foreign bodies in our cases. Awareness of this problem is necessary to avoid unnecessary mortality in surgical patients.

A deep learning model based on fusion images of chest radiography and X-ray sponge images supports human visual characteristics of retained surgical items detection.

Although a novel deep learning software was proposed using post-processed images obtained by the fusion between X-ray images of normal post-operative radiography and surgical sponge, the association of the retained surgical item detectability with human visual evaluation has not been sufficiently examined. In this study, we investigated the association of retained surgical item detectability between deep learning and human subjective evaluation. A deep learning model was constructed from 2987 training images and 1298 validation images, which were obtained from post-processing of the image fusion between X-ray images of normal post-operative radiography and surgical sponge. Then, another 800 images were used, i.e., 400 with and 400 without surgical sponge. The detection characteristics of retained sponges between the model and a general observer with 10-year clinical experience were analyzed using the receiver operator characteristics. The following values from the deep learning model and observer were, respectively, derived: Cutoff values of probability were 0.37 and 0.45; areas under the curves were 0.87 and 0.76; sensitivity values were 85% and 61%; and specificity values were 73% and 92%. For the detection of surgical sponges, we concluded that the deep learning model has higher sensitivity, while the human observer has higher specificity. These characteristics indicate that the deep learning system that is complementary to humans could support the clinical workflow in operation rooms for prevention of retained surgical items.

Gossypiboma as a rare complication of septoplasty procedure: case report and review of literatures

BackgroundForeign body granuloma due to retained surgical sponge is also called gossypiboma. Only one case of nasal septum gossypiboma has been reported.In this report, we present a case of retained surgical sponge at the septoplasty site.Case presentationA 16-year-old male patient came to our emergency department complaining of nasal obstruction associated with low-grade fever. With past history of septoplasty 3 months ago. Endoscopic examination of the nasal cavity revealed bilateral smooth swelling of the nasal septum, no fluid was detected with aspiration. A CT scan of the nose and paranasal sinuses revealed significant posterior septal swelling. A consent had been taken from the parents, and the patient was prepared for endoscopic exploration under general anesthesia. Elevation of bilateral mucoperichondrial and mucoperiosteal flaps was done. There was a firm swelling with intense reaction all around, after meticulous dissection of this lesion and was delivered with Blakesley forceps. On closer examination it was a missed cotton ball. The patient follow-up for 12 months was excellent with complete disappearance of his complaints.ConclusionsRetained surgical items should be considered in the differential diagnosis of post-operative nasal septum swellings. Sponges used for nasal surgery should be of appropriate size and attached to a thread and should be counted.

Automatic detection of foreign body objects in neurosurgery using a deep learning approach on intraoperative ultrasound images: From animal models to first in-human testing.

Objects accidentally left behind in the brain following neurosurgical procedures may lead to life-threatening health complications and invasive reoperation. One of the most commonly retained surgical items is the cotton ball, which absorbs blood to clear the surgeon's field of view yet in the process becomes visually indistinguishable from the brain parenchyma. However, using ultrasound imaging, the different acoustic properties of cotton and brain tissue result in two discernible materials. In this study, we created a fully automated foreign body object tracking algorithm that integrates into the clinical workflow to detect and localize retained cotton balls in the brain. This deep learning algorithm uses a custom convolutional neural network and achieves 99% accuracy, sensitivity, and specificity, and surpasses other comparable algorithms. Furthermore, the trained algorithm was implemented into web and smartphone applications with the ability to detect one cotton ball in an uploaded ultrasound image in under half of a second. This study also highlights the first use of a foreign body object detection algorithm using real in-human datasets, showing its ability to prevent accidental foreign body retention in a translational setting.

Strategies to prevent inadvertent retained surgical items: An integrative review

Background: The surgical count process is currently the recommended strategy for preventing unintentionally retained surgical items (RSIs) in Australia. Despite this, RSIs still occur and remain an internationally recognised issue and sentinel event associated with morbidity and mortality. There are numerous new and emerging strategies to prevent inadvertent RSIs, apart from the surgical count, and many involve the use of technology. These strategies are not currently specified in Standards for Perioperative Nursing in Australia (the ACORN Standards).

Un curieux cas de masse cardiaque : à propos d'un cas

BackgroundRetained foreign bodies are dreadful events associated with invasive procedures. Their occurrence implicate physical complications as well as serious professional and medico-legal consequences. Cases of retained surgical items, in the pericardial space, following cardiothoracic surgery are rare and their management is delicate as the risks of their removal must be thoroughly weighed against the complications of leaving them inside the chest. Case presentationWe report the case of a retained foreign body, discovered in an asymptomatic patient, on a routine medical check-up, 4 years after cardiac surgery. ConclusionsClinical and paraclinical manifestations of retained surgical foreign bodies are nonspecific. The progress of cardiac imaging means makes it possible to identify these rare foreign bodies with greater precision, and allows, with extreme caution, to monitor patients who are perfectly asymptomatic and who are reluctant to undergo surgery.

38 (PB-038) Poster - Breast cancer axillary dissection a “lost procedure, sometimes still necessary…” how to prevent the lost of a surgical technique using cadaver body and Simlife

Background: Sentinel lymphonodal biopsy (SLB) is nowadays regarded has a standard procedure in breast cancer surgical treatment. Moreover some authors are investigating the option to omit SLB in tumor less than two cm. On the other hand axillary dissection has become a “rare” indication for breast cancer surgery, thus decreasing surgeon performance and the possibility of learning this procedure among young surgeons. To utilize cadaver body for learning is a valuable tool for surgery competence acquisition. Sim- life is a patented device helping cadaver body utilization for learning process. Material and methods: We analyze the ideal steps to learn axillary dissection, for young breast cancer surgeon throughout an individual experience of a trainee. The doctor attended the fourth year specialization school in Gynecology, with a dedicated time (8 months) at the breast cancer treatment at the University of Turin (Breast cancer Unit around 1000 cases per yr). The learning process developed throughout five steps for eight months duration: the first at the master of senology helping teacher in preparing anatomical lesson. The second as assistant in 20 surgical breast cancer procedures. The third as first operator in 20 breast cancer surgical procedures including SLB and starting with treating the axilla (axillary dissection) in a gradual manner. The fourth phase included a cadaver-lab course at University center of Poitier together with the senior tutor for two days, utilizing Sim- life patented device (revitalized cadaver system) and performing 4 complete axillary dissections (both sides per cadaver). In the fifth step the trainee performed two axillary dissections on patients under senior tutor assistance. The trainee had to fill a form developed to describe time of different surgical procedures, surgical difficulties and competences acquisition. Results: Both timing criteria and surgical items increases during the training period of 8 months with a decrease in time performing SLB of 50% (p = 0.005) and increase of more than 80% (p = 0.04) in competence acquisition in identifying anatomical structures during axillary dissection procedure in a statistically significant manner. Trainee self- confidence was also increased together with satisfaction even from a psychological point of view (data registered with a questionnaire). Conclusions: Programmed learning/tutoring process through pre-defined steps, in association with cadaver-lab, Sim-life device and hands-on practice improve surgical competences acquisition permitting practice also surgery that nowadays remains necessary, even though more rarely than in the past according to clinical indications, such as axillary dissection. No conflict of interest.