http://www.pssjournal.com The most accessed research articles published by Patient Safety in Surgery 2011-04-12T00:00:00Z BackroundOpen or laparoscopic colorectal surgery comprises of many different types of procedures for various diseases. Depending upon the operation and modifiable and non-modifiable risk factors the intra- and postoperative morbidity and mortality rate vary. In general, surgical complications can be divided into intraoperative and postoperative complications and usually occur while the patient is still in the hospital. Methods: A literature search (1980-2009) was carried out, using MEDLINE, PubMed and the Cochrane library. Results: This review provides an overview how to identify and minimize intra- and postoperative complications. The improvement of different treatment strategies and technical inventions in the recent decade has been enormous. This is mainly attributable to the increase in the laparoscopic approach, which is now well accepted for many procedures. Training of the surgeon, hospital volume and learning curves are becoming increasingly more important to maximize patient safety, surgeon expertise and cost effectiveness. In addition, standardization of perioperative care is essential to minimize postoperative complications. Conclusion: This review summarizes the main perioperative complications of colorectal surgery and influencable and non-influencable risk factors which are important to the general surgeon and the relevant specialist as well. In order to minimize or even avoid complications it is crucial to know these risk factors and strategies to prevent, treat or reduce intra- and postoperative complications. http://www.pssjournal.com/content/4/1/5 Philipp Kirchhoff Pierre-Alain Clavien Dieter Hahnloser Patient Safety in Surgery 2010, null:5 2010-03-25T00:00:00Z doi:10.1186/1754-9493-4-5 /content/figures/1754-9493-4-5-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 5 2010-03-25T00:00:00Z XML Despite the introduction of the Universal Protocol, patient safety in surgery remains a daily challenge in the operating room. This present study describes one community health system's efforts to improve operating room safety through human factors training and ultimately the development of a surgical checklist. Using a combination of formal training, local studies documenting operating room safety issues and peer to peer mentoring we were able to substantially change the culture of our operating room. Our efforts have prepared us for successfully implementing a standardized checklist to improve operating room safety throughout our entire system. Based on these findings we recommend a multimodal approach to improving operating room safety. http://www.pssjournal.com/content/3/1/25 Scott Hurlbert Jill Garrett Patient Safety in Surgery 2009, null:25 2009-11-20T00:00:00Z doi:10.1186/1754-9493-3-25 /content/figures/1754-9493-3-25-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 25 2009-11-20T00:00:00Z XML Background: System analyses of incidents that occur in the process of health care delivery are rare. A case study of a series of incidents that one of the authors experienced after routine urologic surgery is presented. We interpret the sequence of events as a case of cascading incidents that resulted in outcomes that were suboptimal, although fortunately not fatal. Methods: A system dynamics approach was employed to develop illustrative models (flow diagrams) of the dynamics of the patient's interaction with surgery and emergency departments. The flow diagrams were constructed based upon the experience of the patient, chart review, discussion with the involved physicians as well as several physician colleagues, comparison of our diagrams with those developed by the hospital of interest for internal planning purposes, and an iterative process with one of the co-authors who is a system dynamics expert. A dynamic hypothesis was developed using insights gained by building the flow diagrams. Results: The incidents originated in design flaws and many small innocuous system changes that have occurred incrementally over time, which by themselves may have no consequence but in conjunction with some system randomness can have serious consequences. In the patient's case, the incidents that occurred in preoperative assessment and surgery originated in communication and procedural failures. System delays, communication failures, and capacity issues contributed largely to the subsequent incidents. Some of these issues were controllable by the physicians and staff of the institution, whereas others were less controllable. To the system's credit, some of the more controllable issues were addressed, but systemic problems like overcrowding are unlikely to be addressed in the near future. Conclusion: This is first instance that we are aware of in the literature where a system dynamics approach has been used to analyze a patient safety experience. The qualitative system dynamics analysis was useful in understanding the system, and contributed to learning on the part of some components of the system. We suggest that further data collection and quantitative analysis would be highly informative for identification of system changes to improve quality and safety. http://www.pssjournal.com/content/3/1/1 Robert Lee David Cooke Michael Richards Patient Safety in Surgery 2009, null:1 2009-01-06T00:00:00Z doi:10.1186/1754-9493-3-1 /content/figures/1754-9493-3-1-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 1 2009-01-06T00:00:00Z XML Vaginal evisceration in premenopausal women after trans-abdominal hysterectomy is extremely rare in occurrence and only few cases have been documented in worldwide literature. Here we report a premenopausal woman with coitus induced trans-vaginal evisceration who had undergone trans-abdominal hysterectomy two years ago.This article highlights coitus as a trigger event for inducing vaginal evisceration and that vaginal evisceration caused by sexual intercourse should be considered in the field of surgery when a pre-menopausal woman presents with acute abdominal pain with no history of any other traumatic episode. http://www.pssjournal.com/content/5/1/6 Nishikant Gujar Ravikumar Choudhari Geeta Choudhari Nasheen Bagali Mahendra Bendre Santosh Adgale Patient Safety in Surgery 2011, null:6 2011-04-12T00:00:00Z doi:10.1186/1754-9493-5-6 /content/figures/1754-9493-5-6-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 6 2011-04-12T00:00:00Z XML Background: Ischemic orchitis is an established complication after open inguinal hernia repair, but ischemic orchitis resulting in orchiectomy after the laparoscopic approach has not been reported.Case presentationThe patient was a thirty-three year-old man who presented with bilateral direct inguinal hernias, right larger than left. He was a thin, muscular male with a narrow pelvis who underwent bilateral extraperitoneal mesh laparoscopic inguinal hernia repair. The case was complicated by pneumoperitoneum which limited the visibility of the pelvic anatomy; however, the mesh was successfully deployed bilaterally. Cautery was used to resect the direct sac on the right. The patient was discharged the same day and doing well with minimal pain and swelling until the fourth day after surgery. That night he presented with sudden-onset pain and swelling of his right testicle and denied both trauma to the area and any sexual activity. Ultrasound of the testicle revealed no blood flow to the testicle which required exploration and subsequent orchiectomy. Conclusion: Ischemic orchitis typically presents 2–3 days after inguinal hernia surgery and can progress to infarction. This ischemic injury is likely due to thrombosis of the venous plexus, rather than iatrogenic arterial injury or inappropriate closure of the inguinal canal. Ultrasound/duplex scanning of the postoperative acute scrotum can help differentiate ischemic orchitis from infarction. Unfortunately, testicular torsion cannot be ruled out and scrotal exploration may be necessary. Although ischemic orchitis, atrophy, and orhiectomy are uncommon complications, all patients should be warned of these potential complications and operative consent should include these risks irrespective of the type of hernia or the surgical approach. http://www.pssjournal.com/content/1/1/3 John Moore Erik Hasenboehler Patient Safety in Surgery 2007, null:3 2007-11-07T00:00:00Z doi:10.1186/1754-9493-1-3 /content/figures/1754-9493-1-3-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 3 2007-11-07T00:00:00Z XML Adolescent idiopathic scoliosis (AIS) represents a rare condition with a potentially detrimental impact on young patients. Despite vast clinical research and published treatment guidelines and algorithms, the optimal therapeutic choice for these patients remains highly controversial. While advocates of early surgery emphasize the benefits of surgical deformity correction with regard to physical and psychological outcome, the opponents base their arguments on the high risk of complications and a lack of documented subjective long-term outcome. In the present paper, the authors were invited to debate the opposite positions of "pro" versus "contra" surgical treatment of AIS, based on the currently available evidence and published guidelines. http://www.pssjournal.com/content/2/1/25 Hans-Rudolf Weiss Shay Bess Man Sang Wong Vikas Patel Deborah Goodall Evalina Burger Patient Safety in Surgery 2008, null:25 2008-09-30T00:00:00Z doi:10.1186/1754-9493-2-25 /content/figures/1754-9493-2-25-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 25 2008-09-30T00:00:00Z XML The publication date of this editorial marks the 5th anniversary of the "Universal Protocol" which became a mandatory quality standard introduced by the Joint Commission on July 1, 2004. http://www.pssjournal.com/content/3/1/14 Philip Stahel Philip Mehler Ted Clarke Jeffrey Varnell Patient Safety in Surgery 2009, null:14 2009-07-01T00:00:00Z doi:10.1186/1754-9493-3-14 /content/figures/1754-9493-3-14-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 14 2009-07-01T00:00:00Z XML Background: Respiratory alarm monitoring and rapid response team alerts on hospital general floors are based on detection of simple numeric threshold breaches. Although some uncontrolled observation trials in select patient populations have been encouraging, randomized controlled trials suggest that this simplistic approach may not reduce the unexpected death rate in this complex environment. The purpose of this review is to examine the history and scientific basis for threshold alarms and to compare thresholds with the actual pathophysiologic patterns of evolving death which must be timely detected. Methods: The Pubmed database was searched for articles relating to methods for triggering rapid response teams and respiratory alarms and these were contrasted with the fundamental timed pathophysiologic patterns of death which evolve due to sepsis, congestive heart failure, pulmonary embolism, hypoventilation, narcotic overdose, and sleep apnea. Results: In contrast to the simplicity of the numeric threshold breach method of generating alerts, the actual patterns of evolving death are complex and do not share common features until near death. On hospital general floors, unexpected clinical instability leading to death often progresses along three distinct patterns which can be designated as Types I, II and III. Type I is a pattern comprised of hyperventilation compensated respiratory failure typical of congestive heart failure and sepsis. Here, early hyperventilation and respiratory alkalosis can conceal the onset of instability. Type II is the pattern of classic CO2 narcosis. Type III occurs only during sleep and is a pattern of ventilation and SPO2 cycling caused by instability of ventilation and/or upper airway control followed by precipitous and fatal oxygen desaturation if arousal failure is induced by narcotics and/or sedation. Conclusion: The traditional threshold breach method of detecting instability on hospital wards was not scientifically derived; explaining the failure of threshold based monitoring and rapid response team activation in randomized trials. Furthermore, the thresholds themselves are arbitrary and capricious. There are three common fundamental pathophysiologic patterns of unexpected hospital death. These patterns are too complex for early detection by any unifying numeric threshold. New methods and technologies which detect and identify the actual patterns of evolving death should be investigated. http://www.pssjournal.com/content/5/1/3 Lawrence Lynn J. Curry Patient Safety in Surgery 2011, null:3 2011-02-11T00:00:00Z doi:10.1186/1754-9493-5-3 /content/figures/1754-9493-5-3-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 3 2011-02-11T00:00:00Z XML Background: Femoral neck fractures in the elderly are frequent, represent a great health care problem, and have a significant impact on health insurance costs. Reconstruction options using hip arthroplasty include unipolar or bipolar hemiarthroplasty (HA), and total hip arthroplasty (THA). The purpose of this review is to discuss the indications, limitations, and pitfalls of each of these techniques. Methods: The Pubmed database was searched for all articles on femoral neck fracture and for the reconstruction options presented in this review using the search terms "femoral neck fracture", "unipolar hemiarthroplasty", "bipolar hemiarthroplasty", and "total hip arthroplasty". In addition, cross-referencing was used to cover articles eventually undetected by the respective search strategies. The resulting articles were then reviewed with regard to the different techniques, outcome and complications of the distinct reconstruction options. Results: THA yields the best functional results in patients with displaced femoral neck fractures with complication rates comparable to HA. THA is beneficially implanted using an anterior approach exploiting the internervous plane between the tensor fasciae latae and the sartorius muscles allowing for immediate full weight-bearing. Based on our findings, bipolar hemiarthroplasty, similar to unipolar hemiarthroplasty, cannot restorate neither anatomical nor biomechanical features of the hip joint. Therefore, it can only be recommended as a second line of defense-procedure for patients with low functional demands and limited live expectancy. Conclusions: THA is the treatment of choice for femoral neck fractures in patients older than 60 years. HA should only be implanted in patients with limited life expectancy. http://www.pssjournal.com/content/4/1/16 Christian Ossendorf Max Scheyerer Guido Wanner Hans-Peter Simmen Clement Werner Patient Safety in Surgery 2010, null:16 2010-10-20T00:00:00Z doi:10.1186/1754-9493-4-16 /content/figures/1754-9493-4-16-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 16 2010-10-20T00:00:00Z XML Background: Kyphoplasty represents an established minimal-invasive method for correction and augmentation of osteoporotic vertebral fractures. Reliable data on perioperative and postoperative complications are lacking in the literature. The present study was designed to evaluate the incidence and patterns of perioperative complications in order to determine the safety of this procedure for patients undergoing kyphoplasty.Patients and MethodsWe prospectively enrolled 102 consecutive patients (82 women and 20 men; mean age 69) with 135 operatively treated fractured vertebrae who underwent a kyphoplasty between January 2004 to June 2006. Clinical and radiological follow-up was performed for up 6 months after surgery. Results: Preoperative pain levels, as determined by the visual analogous scale (VAS) were 7.5 +/- 1.3. Postoperative pain levels were significantly reduced at day 1 after surgery (VAS 2.3 +/- 2.2) and at 6-month follow-up (VAS 1.4 +/- 0.9). Fresh vertebral fractures at adjacent levels were detected radiographically in 8 patients within 6 months. Two patients had a loss of reduction with subsequent sintering of the operated vertebrae and secondary spinal stenosis. Accidental cement extravasation was detected in 7 patients in the intraoperative radiographs. One patient developed a postoperative infected spondylitis at the operated level, which was treated by anterior corporectomy and 360 degrees fusion. Another patient developed a superficial wound infection which required surgical revision. Postoperative bleeding resulting in a subcutaneous haematoma evacuation was seen in one patient. Conclusion: The data from the present study imply that percutaneous kyphoplasty can be associated with severe intra- and postoperative complications. This minimal-invasive surgical procedure should therefore be performed exclusively by spine surgeons who have the capability of managing perioperative complications. http://www.pssjournal.com/content/2/1/2 Yohan Robinson Sven Kevin Tschoeke Philip Stahel Ralph Kayser Christoph Heyde Patient Safety in Surgery 2008, null:2 2008-01-15T00:00:00Z doi:10.1186/1754-9493-2-2 /content/figures/1754-9493-2-2-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 2 2008-01-15T00:00:00Z XML