http://www.pssjournal.com The most accessed research articles published by Patient Safety in Surgery 2012-01-20T00:00:00Z 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 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 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 No description available http://www.pssjournal.com/content/3/1/26 Alan Lembitz Ted Clarke Patient Safety in Surgery 2009, null:26 2009-12-31T00:00:00Z doi:10.1186/1754-9493-3-26 /content/figures/1754-9493-3-26-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 26 2009-12-31T00:00:00Z 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 /content/figures/1754-9493-6-2-toc.gif Patient Safety in Surgery 1754-9493 ${item.volume} 2 2012-01-20T00:00:00Z 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 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 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 PDF 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 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