Younger Surgeons More Prone to Mistakes Due to Distractions

Younger, less-experienced surgeons are more prone to distraction in the OR - and to make surgical errors as a result, according to researchers at Oregon State University and the Oregon Health and Science University.

The analysis centered on a simulated laparoscopic cholecystectomy in which surgeons could be distracted by noises, questions, conversation or other commotion in the operating room. Eight of 18 (44%) second-, third- and research-year surgical residents made serious errors, particularly when they were being tested in the afternoon. By comparison, only 1 surgeon made a mistake when there were no distractions.

While the young surgeons, aged 27 to 35, were trying to perform the lap chole, a cell phone would ring, followed later by a metal tray clanging to the floor. Questions would be posed about problems developing with a previous surgical patient - a necessary conversation - and someone off to the side would begin talking about politics, a not-so-necessary but fairly realistic distraction. Interrupting questions caused the most major errors (such as damage to internal organs, ducts and arteries), followed by sidebar conversations. Interestingly, participants facing disruptions did much worse in the afternoons, although conventional fatigue didn't appear to be an issue.

This study, published in Archives of Surgery, sought insights on "human factors engineering," a field seeking to identify why mistakes happen, what approaches or systems can contribute to the errors, and ways to improve performance.

Stephanie Wasek

Discharge Doesn't Limit Patients' Risks

Patients are still at risk for serious post-op complications once they're discharged to home, according to a study in the November issue of Archives of Surgery.

A review of more than 500,000 general surgery cases by researchers at Stanford University in Palo Alto, Calif., revealed that nearly 17% of patients experienced complications, including surgical site infections and blood clots, with 41.5% occurring post-discharge.

The highest rates of post-discharge complications occurred after protectomy, enteric fistula repair and pancreatic procedures, notes the study. Other procedures marked by high rates of post-discharge complications included appendectomy, hernia repair, cholecystectomy and anorectal surgery. Patients with post-discharge complications had higher rates of re-operation and death within 30 days of surgery, according to the report.

The study's authors note post-op complications should be an important focus of quality improvement in general surgery, adding, "Fastidious, procedure-specific patient triage at discharge and expedited patient follow-up could improve post-discharge outcomes."

"Good surgeons know when to operate, who to treat conservatively, and how to minimize morbidity," writes Desmond Winter, MD, in a related commentary. "Great surgeons manage complications expediently and well."

The clinical associate professor in surgery at the University College in Dublin, Ireland, believes patient needs, not financial penalties, should be the driving force behind reducing post-discharge complication risks in the new era of quality reporting. "Let us see further advancements in surgical care through research funded by the proposed insurer savings and together strive for safer surgery," he says.

Daniel Cook

Cartilage Grafts, Fresh From the Printer

Using 2 modern fabrication technologies, a team of North Carolina researchers has developed a way to manufacture artificial cartilage tissue that is reportedly more durable than other artificial options.

Writing in the journal Biofabrication, the researchers described the use of an electrospinning machine, which creates thin polymer fibers, and an ink-jet-like 3-D printer, which shapes a gel solution made from cells from a rabbit's ear.

Layered together into a cartilage structure, the synthetic fibers provide strength while the natural component facilitates cell growth. The researchers, based at the Wake Forest Institute for Regenerative Medicine, tested the structure for its weight-bearing ability and whether the cells remained alive before implanting it in mice.

According to published reports, over the course of 8 weeks the artificial cartilage took on similar properties as actual tissue, introducing the possibility of crafting forms for implantation and regrowth in human joints.

"A careful selection of scaffold material for each patient's construct would allow the implant to withstand mechanical forces while encouraging new cartilage to organize and fill the defect," write the researchers.

David Bernard

InstaPoll: At What Age Do Your Patients Require EKGs?

At what age do you require patients to have EKGs, even if they have no history of heart disease? There's much debate surrounding such pre-anesthesia testing. Does it help detect heart disease and prevent poor surgical outcomes, or is it a waste of healthcare dollars? Weigh in on this week's Outpatient Surgery Magazine InstaPoll.

Last week we asked you to rate the level of teamwork in your OR. The results, based on 444 responses, show that more than 8 out of 10 respondents rate their surgical personnel's teamwork as either excellent (44%) or good (40%). For 14% it's only fair and for an unfortunate 2% it is poor.

Dan O'Connor

News & Notes
  • E-mails improve start times E-mail reminders sent to surgeons requesting them to arrive for surgery 20 minutes early improves first-case on-time starts by 60%, according to research reported in Anesthesiology News. With support from administration, an "on-time committee" charged with sending the e-mails and continuously observing and recording case start times will "keep reducing delays," says Maria Fezza, BSN, RN, one of the researchers and nurse manager of perioperative surgical services at New York University's Langone Medical Center in New York City.

  • Joint Commission study promotes safety improvements Patient safety is healthcare's primary focus, but it is often overlooked that healthcare employees see more non-fatal on-the-job injuries than construction and manufacturing workers. In a new study available for free download, the Joint Commission (in conjunction with national safety agencies) explores the connection between worker and patient safety and how both can and must be improved.

  • Seal of approval for AAAHC CMS has renewed accreditor AAAHC's Medicare-deemed status for ASCs through 2018. The AAAHC has held deemed status for ASCs since 1996. ASCs accredited after undergoing the AAAHC/Medicare deemed status survey demonstrate to CMS that their quality of care meets or exceeds that mandated for participation in Medicare and Medicaid.