http://www.pssjournal.com The latest research articles published by Patient Safety in Surgery 2012-05-18T00:00:00Z Background: Outcome measurement in shoulder surgery is essential to evaluate the patient safety andtreatment efficiency. Currently this is jeopardized by the fact that most patient-reported selfassessmentinstruments are not comparable. Hence, the aim was to develop a reliable selfassessmentquestionnaire which allows an easy follow-up of patients. The questionnaire alsoallows the calculation of 3 well established scoring systems, i.e. the Shoulder Pain andDisability Index (SPADI), the Constant-Murley Score (CMS), and the Disabilities of theArm, Shoulder and Hand (DASH) Score. The subjective and objective items of these threesystems were condensed into a single 30-questions form and validated against the originalquestionnaires. Methods: A representative collective of patients of our shoulder clinic was asked to fill in the newlydesigned self-assessment Munich Shoulder Questionnaire (MSQ). At the same time, theestablished questionnaires for self-assessment of CONSTANT, SPADI and DASH scoreswere handed out. The obtained results were compared by linear regression analysis. Results: Fifty one patients completed all questionnaires. The correlation coefficients of the resultswere r = 0.91 for the SPADI, r = -0.93 for the DASH and r = 0.94 for the CMS scoring system,respectively. Conclusions: We developed an instrument which allows a quantitative self-assessment of shoulderfunction. It provides compatible data sets for the three most popular shoulder function scoringsystems by one single, short 30-item. This instrument can be used by shoulder surgeons toeffectively monitor the outcome, safety and quality of their treatment and also compare theresults to published data in the literature. http://www.pssjournal.com/content/6/1/9 Florian Schmidutz Marc Beirer Volker Braunstein Viktoria Bogner Ernst Wiedemann Peter Biberthaler Patient Safety in Surgery 2012, null:9 2012-05-18T00:00:00Z doi:10.1186/1754-9493-6-9 /content/figures/1754-9493-6-9-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 9 2012-05-18T00:00:00Z PDF Background: The adoption of robotic assistance has contributed to the increased utilization of partial nephrectomy for the management of renal tumors. However, partial nephrectomy can be technically challenging because of intraoperative hemorrhage, which limits the ability to identify the tumor margin and may necessitate the conversion to open surgery or radical nephrectomy. To our knowledge, a comprehensive safety checklist does not exist to guide surgeons on the management of hemorrhage during robotic partial nephrectomy. We developed such an safety checklist based on the cumulative experiences of high volume robotic surgeons. Methods: A treatment safety checklist for the management of hemorrhage during robotic partial nephrectomy was collaboratively developed based on prior experiences with intraoperative hemorrhage during robotic partial nephrectomy. Results: Reducing the risk of hemorrhage during robotic partial nephrectomy begins with reviewing the preoperative imaging for renal vasculature and tumor anatomy, with a focus on accessory vessels and renal tumor proximity to the renal hilum. During hilar exposure, an attempt is made to identify additional accessory renal arteries. The decision is then made on whether to clamp the hilum (artery +/- vein). If bleeding is encountered during resection, management is based on whether the bleeding is suspected to be arterial or from venous backbleeding. Operative maneuvers that may increase the chance of success are highlighted in safety checklists for arterial and venous bleeding. Conclusions: Safely performing robotic partial nephrectomy is dependent on attention to prevention of hemorrhage and rapid response to the challenge of intraoperative bleeding. Preparation is essential for maximizing the chance of success during robotic partial nephrectomy. http://www.pssjournal.com/content/6/1/8 Kenneth Nepple Gurdarshan Sandhu Craig Rogers Mohamad Allaf Jihad Kaouk Robert Figenshau Michael Stifelman Sam Bhayani Patient Safety in Surgery 2012, null:8 2012-04-02T00:00:00Z doi:10.1186/1754-9493-6-8 /content/figures/1754-9493-6-8-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 8 2012-04-02T00:00:00Z XML Background: Placement of external fixation frames is an expedient and minimally invasive method of achieving bone and joint stability in the setting of severe trauma. Although anatomic safe zones are established for placement of external fixation pins, neurovascular structures may be at risk in the setting of severe trauma.Case reportWe present a case of a 21-year-old female involved in a high speed motorcycle accident who sustained a Type IIIB open segmental femur fracture with significant thigh soft tissue injury. Damage control orthopedic principals were applied and a spanning external fixator placed for provisional femoral stabilization. Intraoperative vascular examination noted absent distal pulses, however an intraoperative angiogram showed arterial flow distal to the trifurcation. Immediately postoperatively the dorsalis pedis pulse was detected using Doppler ultrasound but was then non-detectable over the preceding 12-hours. Femoral artery CT angiogram revealed iatrogenic superficial femoral artery occlusion due to kinking of the artery around an external fixator pin. Although the pin causing occlusion was placed under direct visualization, the degree of soft tissue injury altered the appearance of the local anatomy. The pin was subsequently revised allowing the artery to travel in its anatomic position, restoring perfusion. Conclusion: This case highlights the dangers associated with damage control orthopedics, especially when severe trauma alters normal local anatomy. Careful assessment of external fixator pin placement is crucial to avoiding iatrogenic injury. We recommend a thorough vascular examination pre-operatively and prior to leaving the operating room, which allows any abnormalities to be further evaluated while the patient remains in a controlled environment. When an unrecognized iatrogenic injury occurs, serial postoperative neurovascular examinations allow early recognition and corrective actions. http://www.pssjournal.com/content/6/1/7 Gregory Staeheli Michael Fraser Steven Morgan Patient Safety in Surgery 2012, null:7 2012-03-26T00:00:00Z doi:10.1186/1754-9493-6-7 /content/figures/1754-9493-6-7-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 7 2012-03-26T00:00:00Z XML Calcaneal fractures are common injuries involving the hind foot and often a source of significant long-term morbidity. Treatment options have changed throughout the ages from periods of preferred nonoperative management to closed reduction with a mallet, and more recently, open reduction and anatomic internal fixation. The current treatment of choice; however, is often debated, as open management of these fractures carries many risks to include wound breakdown and infection. A less invasive form of surgical management through small incisions, while maintaining the ability to obtain joint congruency, anatomic alignment, and restore calcaneal height and width would be ideal. We propose a novel form of fracture reduction using an inflatable bone tamp and percutaneous fracture fixation. Preoperative planning and experienced fluoroscopy is crucial to successful management using this method. Although we achieved successful radiographic outcome in this case, long-term functional outcome of this technique are yet to be published. http://www.pssjournal.com/content/6/1/6 Cyril Mauffrey James Bailey David Hak Mark Hammerberg Patient Safety in Surgery 2012, null:6 2012-03-15T00:00:00Z doi:10.1186/1754-9493-6-6 /content/figures/1754-9493-6-6-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 6 2012-03-15T00:00:00Z XML Background: Muscle herniation of the leg is a rare clinical entity. Yet, knowing this condition is necessary to avoid misdiagnosis and delayed treatment. In the extremities, muscle herniation most commonly occurs as a result of an acquired fascial defect, often due to trauma. Different treatment options for symptomatic extremity muscle herniation in the extremities, including conservative treatment, fasciotomy and mesh repair have been described.Case presentationWe present the case of a patient who presented with prolonged symptoms after an ankle sprain. The clinical picture showed a fascial insufficiency with muscle bulging under tension. Ultrasound and MRI imaging confirmed the diagnosis of muscle hernia of the medial gastrocnemius on the right leg. Conservative treatment did not lead to success. Therefore, the fascial defect was treated surgically by repairing the muscle herniation using a synthetic vicryl propylene patch. Conclusions: Muscle hernias should be taken into consideration as a rare differential diagnosis whenever patients present with persisting pain or soft tissue swelling after ankle sprain. Diagnosis is mainly based on clinical aspect and physical examination, but can be confirmed by radiologic imaging techniques, including (dynamic) ultrasound and MRI. If conservative treatment fails, we recommend the closure with mesh patches for large fascial defects. http://www.pssjournal.com/content/6/1/5 Greta Bergmann Bernhard Ciritsis Guido Wanner Hans-Peter Simmen Clement Werner Georg Osterhoff Patient Safety in Surgery 2012, null:5 2012-03-14T00:00:00Z doi:10.1186/1754-9493-6-5 /content/figures/1754-9493-6-5-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 5 2012-03-14T00:00:00Z XML Today, skeletal tibial traction remains a mainstay of initial management following high-energy, major orthopaedic lower extremity trauma. Historically utilized as definitive fracture management, recent advances in surgical technology have moved skeletal tibial traction into the realm of temporary management, with benefits including fracture reduction, pain relief, and restoration of disturbed surrounding soft tissues, lowering wound complication and compartment syndrome rates. However, no procedure is without its risks. Here, we present a case of common peroneal palsy following skeletal tibial traction placement, which resolved with subsequent pin removal. Indications, proper placement, potential etiologies, and a review of the literature are also discussed. http://www.pssjournal.com/content/6/1/4 Frank Liporace Richard Yoon Anil Kesani Patient Safety in Surgery 2012, null:4 2012-02-21T00:00:00Z doi:10.1186/1754-9493-6-4 /content/figures/1754-9493-6-4-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 4 2012-02-21T00:00:00Z XML Background: Some tetraplegic patients may wish to undergo urological procedures without anaesthesia, but these patients can develop autonomic dysreflexia if cystoscopy and vesical lithotripsy are performed without anaesthesia.Case presentationWe describe three tetraplegic patients, who developed autonomic dysreflexia when cystoscopy and laser lithotripsy were carried out without anesthesia.In two patients, who declined anaesthesia, blood pressure increased to more than 200/110 mmHg during cystoscopy. One of these patients developed severe bleeding from bladder mucosa and lithotripsy was abandoned. Laser lithotripsy was carried out under subarachnoid block a week later in this patient, and this patient did not develop autonomic dysreflexia.The third patient with C-3 tetraplegia had undergone correction of kyphoscoliotic deformity of spine with spinal rods and pedicular screws from the level of T-2 to S-2. Pulmonary function test revealed moderate to severe restricted curve. This patient developed vesical calculus and did not wish to have general anaesthesia because of possible need for respiratory support post-operatively. Subarachnoid block was not considered in view of previous spinal fixation. When cystoscopy and laser lithotripsy were carried out under sedation, blood pressure increased from 110/50 mmHg to 160/80 mmHg. Conclusion: These cases show that tetraplegic patients are likely to develop autonomic dysreflexia during cystoscopy and vesical lithotripsy, performed without anaesthesia. Health professionals should educate spinal cord injury patients regarding risks of autonomic dysreflexia, when urological procedures are carried out without anaesthesia. If spinal cord injury patients are made aware of potentially life-threatening complications of autonomic dysreflexia, they are less likely to decline anaesthesia for urological procedures. Subrachnoid block or epidural meperidine blocks nociceptive impulses from urinary bladder and prevents occurrence of autonomic dysreflexia. If spinal cord injury patients with lesions above T-6 decline anaesthesia, nifedipine 10 mg should be given sublingually prior to cystoscopy to prevent increase in blood pressure due to autonomic dysreflexia. http://www.pssjournal.com/content/6/1/3 Subramanian Vaidyanathan Bakul Soni Fahed Selmi Gurpreet Singh Cristian Esanu Peter Hughes Tun Oo Kamesh Pulya Patient Safety in Surgery 2012, null:3 2012-02-20T00:00:00Z doi:10.1186/1754-9493-6-3 /content/figures/1754-9493-6-3-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 3 2012-02-20T00:00:00Z XML Background: Objective data on the incidence and pattern of adverse events after orthopaedic surgical procedures remain scarce, secondary to the reluctance for encompassing reporting of surgical complications. The aim of this study was to analyze the nature of adverse events after orthopaedic surgery reported to a national database for patient claims in Sweden. Methods: In this retrospective review data from two Swedish national databases during a 4-year period were analyzed. We used the "County Councils' Mutual Insurance Company", a national no-fault insurance system for patient claims, and the "National Patient Register at the National Board of Health and Welfare". Results: A total of 6,029 patient claims filed after orthopaedic surgery were assessed during the study period. Of those, 3,336 (55%) were determined to be adverse events, which received financial compensation. Hospital-acquired infections and sepsis were the most common causes of adverse events (n = 741; 22%). The surgical procedure that caused the highest rate of adverse events was "decompression of spinal cord and nerve roots" (code ABC**), with 168 adverse events of 17,507 hospitals discharges (1%). One in five (36 of 168; 21.4%) injured patient was seriously disabled or died. Conclusions: We conclude that patients undergoing spinal surgery run the highest risk of being severely injured and that these patients also experienced a high degree of serious disability. The most common adverse event was related to hospital acquired infections. Claims data obtained in a no-fault system have a high potential for identifying adverse events and learning from them. http://www.pssjournal.com/content/6/1/2 Annica Ohrn Johan Elfstrom Hans Tropp Hans Rutberg Patient Safety in Surgery 2012, null:2 2012-01-20T00:00:00Z doi:10.1186/1754-9493-6-2 Incidence of adverse events after orthopaedic surgery Analysis of adverse events after orthopaedic surgery from a Swedish database for patient claims show hospital-acquired infections and sepsis were the most common causes, and spinal surgery put patients at the highest risk of an injury or adverse event. /content/figures/1754-9493-6-2-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 2 2012-01-20T00:00:00Z XML Malignant pheochromocytoma is a neuroendocrine tumor that originates from chromaffin tissue. Although osseous metastases are common, metastatic dissemination to the spine rarely occurs.Five years after primary diagnosis of extra-adrenal, abdominal pheochromocytoma and laparoscopic extirpation, a 53-year old patient presented with recurrence of pheochromocytoma involving the spine, the pelvis, both proximal femora and the right humerus. Magnetic resonance imaging and computed tomography revealed osteolytic lesions of numerous vertebrae (T1, T5, T10, and T12). In the case of T10, total destruction of the vertebral body with involvement of the rear edge resulted in the risk of vertebral collapse and subsequent spinal stenosis. Thus, dorsal instrumentation (T8-T12) and cement augmentation of T12 was performed after perioperative alpha- and beta-adrenergic blockade with phenoxybenzamine and bisoprolol.After thorough preoperative evaluation to assess the risk for surgery and anesthesia, and appropriate perioperative management including pharmacological antihypertensive treatment, dorsal instrumentation of T8-T12 and cement augmentation of T12 prior to placing the corresponding pedicle screws did not result in hypertensive crisis or hemodynamic instability due to the release of catecholamines from metastatic lesions.To the authors' knowledge, this is the first report describing cement-augmentation in combination with dorsal instrumentation to prevent osteolytic vertebral collapse in a patient with metastatic pheochromocytoma. With appropriate preoperative measures, cement-augmented dorsal instrumentation represents a safe approach to stabilize vertebral bodies with metastatic malignant pheochromocytoma. Nevertheless, direct manipulation of metastatic lesions should be avoided as far as possible in order to minimize the risk of hemodynamic complications. http://www.pssjournal.com/content/6/1/1 Daniel Rittirsch Edouard Battegay Lukas Zimmerli Werner Baulig Donat Spahn Christian Ossendorf Guido Wanner Hans-Peter Simmen Clement Werner Patient Safety in Surgery 2012, null:1 2012-01-05T00:00:00Z doi:10.1186/1754-9493-6-1 /content/figures/1754-9493-6-1-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 1 2012-01-05T00:00:00Z XML Background: Wrong site surgery is one of five surgical "Never Events," which include performing surgery on the incorrect side or incorrect site, performing the wrong procedure, performing surgery on the wrong patient, unintended retention of a foreign object in a patient, and intraoperative/immediate postoperative death in an ASA Class I patient. In the spine, wrong site surgery occurs when a procedure is performed on an unintended vertebral level. Despite the efforts of national safety protocols, literature suggests that the risk for wrong level spine surgery remains problematic.Case PresentationA 34-year-old male was referred to us to evaluate his persistent thoracic pain following right-sided microdiscectomy at T7-8 at an outside institution. Postoperative imaging showed the continued presence of a herniated disc at T7-8 and evidence of a microdiscectomy at the level immediately above. The possibility that wrong level surgery had occurred was discussed with the patient and revision surgery was planned. During surgery, the site of the previous laminectomy was clearly visualized; however, we also experienced confusion when verifying the level of the previous surgery. We ultimately used the previous laminectomy site as a landmark for identifying and treating the correct pathologic level. Postoperative consultation with Musculoskeletal Radiology revealed the patient had two abnormalities in his spinal anatomy that made intraoperative counting of levels inaccurate, including a pair of cervical ribs at C7 and the absence of a pair of thoracic ribs. Conclusion: This case highlights the importance of strict adherence to a preoperative method of vertebral labeling that focuses on the landmarks used to label a pathologic disc space, rather than simply relying on the reference to a particular level. That is, by designating the pathological level as the disc space associated with the fourth rib up from the last rib-bearing vertebrae, rather than calling it "T7-8", then the correct level can be found intraoperatively even in the case of abnormal segmentation. We recommend working closely with radiology during preoperative planning to identify unusual anatomy that may have been overlooked. We also recommend that radiology colleagues use the same system of identifying pathological levels when dictating their reports. Together, these strategies can reduce the risk of wrong level surgery and increase patient safety. http://www.pssjournal.com/content/5/1/33 Emily Lindley Sergiu Botolin Evalina Burger Vikas Patel Patient Safety in Surgery 2011, null:33 2011-12-14T00:00:00Z doi:10.1186/1754-9493-5-33 /content/figures/1754-9493-5-33-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 33 2011-12-14T00:00:00Z XML