Bibliometric analysis of occupational exposure in operating room from 1973 to 2022.

OBJECTIVE: The purpose of this study is to identify and visualize from different perspectives the topic on occupational exposure in operating room (OEOR). METHODS: In the Web of Science Core Collection (WoSCC), all the half-century data were retrieved from January 1st, 1973 to December 31st, 2022. CiteSpace, VOSviewer and Excel 2019 were employed to analyze and visualize data, based on publications, countries, institutions, journals, authors, keywords. RESULT: A total of 336 journal papers were found. The increase of publications virtually started in 1991, peaked in 2020 and has been slowing down ever since. USA played most significant part among all the 49 countries/regions, while Universidade Estadual Paulista out of 499 institutions published the most papers. International Archives of Occupational and Environmental Health bears the most documents and citations in all the 219 retrieved journals. There are 1847 authors found, among whom Hoerauf K is the most influential one. "Occupational exposure", "nitrous oxide" and "operating room personnel" are the top 3 co-occurrences keywords. CONCLUSION: The trend in the field lies in "anaesthetic gas", "blood borne pathogen", "radiation" and "aerosol", while "surgical smoke" and "occupational safety" are the recently researching hot spots in this study. Accurate recognize and effective protection are always essential subjects for researchers.

Treatment of a penetrating inferior vena cava injury using doctor-helicopter emergency medical service and direct-to-operating room resuscitation in Korea: a case report.

Inferior vena cava (IVC) injuries can have fatal outcomes and are associated with high mortality rates. Patients with IVC injuries require multiple procedures, including prehospital care, surgical techniques, and postoperative care. We present the case of a 67-year-old woman who stabbed herself in the abdomen with a knife, resulting in an infrarenal IVC injury. We shortened the transfer time by transporting the patient using a helicopter and decided to perform direct-to-operating room resuscitation by a trauma physician in the helicopter. The patient underwent laparotomy with IVC ligation for damage control during the first operation. The second- and third-look operations, including previous suture removal, IVC reconstruction, and IVC thrombectomy, were performed by a trauma surgeon specializing in cardiovascular diseases. The patient was discharged without major complications on the 19th postoperative day with rivaroxaban as an anticoagulant medication. Computed tomography angiography at the outpatient clinic showed that thrombi in the IVC and both iliac veins had been completely removed. Patients with IVC injuries can be effectively treated using a trauma system that includes fast transportation by helicopter, damage control for rapid hemostasis, and expert treatment of IVC injuries.

Safe Landing: Feasibility and Safety of Operating Room Extubation in Minimally Invasive Cardiac Valve Surgery.

OBJECTIVE: This study was designed to explore key safety outcomes after operating room (OR) extubation in minimally invasive cardiac valve surgery. DESIGN: Single-center retrospective chart review. SETTING: Academic medical center in the United States. PARTICIPANTS: Patients undergoing valvular surgery via thoracotomy (November 2017-October 2022) at a single institution. INTERVENTIONS: The OR extubation protocol was implemented on August 20, 2020. MEASUREMENTS AND MAIN RESULTS: Delirium rates, reintubation rates, and intubation duration were compared before and after OR extubation protocol implementation. Logistic regression identified patient perioperative characteristics associated with unsuccessful OR extubation. Among 312 patients, 254 were extubated in the intensive care unit (ICU) and 58 in the OR. Preoperative demographics were comparable except for the Charlson Comorbidity Index (median: 2.0 ICU extubation v 1.5 OR extubation). Interrupted time series analysis showed no change in postoperative delirium post-OR extubation implementation, with a trend toward decreasing delirium (risk ratio = 0.37, CI: 0.13-1.10, p = 0.07). The postimplementation era also had a lower median intubation duration (8 hours v 13 hours, p < 0.001) without increasing reintubation rates (1.7% v 7.9%, p = 0.159). Increased bypass length (odds ratio = 0.99, CI: 0.98-0.99, p < 0.001), intraoperative morphine milligram equivalents (odds ratio = 0.99, CI: 0.99-1.0, p = 0.009), and preoperative Charlson Comorbidity Index above 3 (odds ratio = 0.42, CI: 0.19-0.95, p = 0.037) were associated with decreased odds of OR extubation. CONCLUSIONS: OR extubation was not associated with increased postoperative delirium or reintubation rates but did decrease intubation duration. Successful OR extubation relies upon the consideration of various patient perioperative characteristics.

Investigation of treatment outcomes for severe extremity trauma in an independent orthopedic trauma center: A case series.

BACKGROUND: Severe extremity trauma is one of the most challenging injuries to treat. Limb salvage after severe extremity trauma requires rapid revascularization, accurate and appropriate bone and soft tissue reconstruction, and appropriate management to address critical complications. The purpose of this study was to report the treatment outcomes for severe extremity trauma injuries at our independent orthopedic trauma center. METHODS: This study included patients with severe extremity trauma who underwent major vascular repair or soft tissue reconstruction. Bone reconstruction method, presence or absence of revascularization, and flap type were investigated. Complications were investigated, including revascularization failure, flap failure, infection, and ultimately, whether amputation was required. Additionally, we investigated the number of surgeries performed on each patient at the time of initial hospitalization. RESULTS: Thirty-five patients who underwent revascularization or soft tissue reconstruction were included in this study. Plate fixation was performed in 18 patients, intramedullary nail fixation in 8, screw fixation in 1, pinning in 4, and without implant fixation in 4. Revascularization was performed in six patients, and no vascular complications occurred. Pedicled and free flaps were used in 17 and 16 patients, respectively. Partial flap necrosis occurred in four patients, and arterial occlusion occurred in one. Infection occurred in 10 patients who were treated with frequent irrigation and high-concentration antibiotics local infusion therapy. None of the 35 patients required limb amputation. Mean number of surgeries was 12.5. CONCLUSIONS: The limb of all the 35 patients with severe extremity trauma treated at our independent orthopedic trauma center were salvaged.

Single-Stage Image-Guided Percutaneous Ablation with Thoracoscopic Resection for Multiple Pulmonary Lesions in a Hybrid Operating Room: A Retrospective Study.

BACKGROUND: Different approaches are required in treating patients with multiple pulmonary lesions. A multistage procedure may increase the risk of complications and patient discomfort. This study reports an initial experience with single-stage management of multiple lung lesions using percutaneous ablation with thoracoscopic resection in a hybrid operating room (HOR). METHODS: We retrospectively evaluated patients who underwent combined ablation and resection in an HOR between May 2022 and July 2024. All patients received a single anesthesia via endotracheal tube intubation. The clinical data, operative findings, and pathological characteristics of the lung nodules were recorded. RESULTS: A total of 22 patients were enrolled in this study. Twenty patients underwent unilateral procedures, while the other two patients underwent bilateral procedures. Ablations were performed before lung resection in 21 patients; only 1 patient underwent surgery first. The median global operating room time was 227.0 min. The median total radiation dose (dose area product) was 14,076 µGym2. The median hospital postoperative length of stay was 2 days. CONCLUSIONS: The single-stage procedure of percutaneous ablation with thoracoscopic resection under general anesthesia in an HOR is feasible and safe. This procedure is an alternative method for managing multiple pulmonary lesions.

Noise, Distractions, and Hazards in the Operating Room.

Anesthesiologists are perioperative leaders of patient and health care team safety. The anesthesiologist needs to remain vigilant in the perioperative setting and while caring for patients. The ability to navigate increased noise levels, distractions, and hazards is crucial for maintaining a safe environment. While some noise, such as music, can have benefits, overall noise levels can distract from patient care and have adverse effects on patient care and intraoperative staff. This study provides an overview of noise, distractions, and hazards in the perioperative environment.

The First Surgery Experienced Through Virtual Reality: A Knee Surgery Case Report.

The decision to undergo surgery and the significance of the operating theater environment are influenced by several factors, which vary from person to person. Negative perceptions of the operating room environment can influence the decision to undergo surgery and the process of treatment. Virtual reality (VR) technology offers the potential to alter individuals' environmental encounters through the provision of diverse environmental perceptions. This case study evaluates the results of a VR simulation applied during surgery to an individual with no previous surgical experience. A male patient scheduled for arthroscopic meniscus surgery was the subject of a VR simulation. The patient's perception of the simulated environment was transmitted through VR goggles from the time he entered the operating room until he left. However, the VR application was terminated during the administration of anesthesia, and no premedication was administered to the patient. The VR application included nature walks in various regions, including forests, lakeshores, and meadows, accompanied by the sound of birds. Data were collected using a visual analog scale to assess pain levels and a walking test form. The patient, a 35-year-old male, is a high school graduate and is undergoing his first surgical procedure. The patient expressed concerns and fears regarding the decision to undergo surgery. The patient's preoperative anxiety was rated at 9 out of 10 but subsequently decreased to 1 out of 10 following the surgical procedure. The patient rated his satisfaction with the surgical experience as 9 out of 10. The patient did not require sedatives or analgesics during the intraoperative period or for the first 10 hours following the operation. The patient was successfully mobilized at the 15-hour mark following surgery. The patient was highly satisfied with the application. The utilization of VR during surgical procedures has the potential to reduce the necessity for premedication and enhance postoperative compliance among patients.

Outcome differences of emergency cesarean delivery in the delivery room versus the operating room: A study based on propensity score matching.

OBJECTIVE: This study sought to compare the risks and outcomes associated with category I cesarean section procedures performed in the delivery room versus those performed in the operating room. PATIENTS AND METHODS: The analysis included 126 singleton pregnant women who underwent inpatient delivery at the Second People's Hospital of Nanning between January 2021 and May 2024. Following propensity score matching, 21 cases were in the delivery room group, and 105 cases were in the operating room group. Parameters under investigation encompassed decision-to-delivery interval, incision-to-delivery interval, surgical duration, intraoperative blood loss, postoperative antibiotic duration, postoperative hospital stay length, postoperative fever incidence, adverse neonatal outcomes, and blood routine parameters. RESULTS: The decision-to-delivery interval was significantly shorter in the delivery room group than in the operating room group. Conversely, the delivery room group exhibited longer surgical durations, higher blood loss, prolonged postoperative antibiotic usage, extended hospital stays, and elevated white blood cell counts with statistical significance (p < 0.05). Nevertheless, no notable variations were observed between the groups in maternal and neonatal outcome indicators, such as adverse neonatal outcomes and postoperative fever rates. CONCLUSIONS: The outcomes suggest that the delivery room group showed increased risks compared with the operating room group, potentially indicating heightened vulnerabilities to bleeding and infection. Hence, it is advisable for patients to undergo surgery in the operating room unless the delivery room is equipped with sterile surgical facilities or in cases of urgent necessity.

Main Operating Room Versus Field Sterility in Hand Surgery: A Review of the Evidence.

Introduction: Many of the guidelines that are generally accepted as main operating room best practices are not evidence based. They are based on the concept that if some sterility is good, more must be better. They are not derived from evidence-based sterility. Evidence-based sterility is the study of which of our various sterility practices increase or decrease our infection rates, as opposed to guidelines based on how many bacteria are in the operating room. Methods: This article adds the most important evidence we could find that is not included in the first paper on evidence-based sterility in hand surgery published in 2019. In this review, we also balance the evidence with common sense opinion. Results: The 21st century has seen a rapid rise in the number and reports of hand surgery procedures performed with field sterility outside the main operating room. There is now an abundance of good evidence to support that the rate of infection is not higher when many hand operations are performed with field sterility in minor procedure rooms. Conclusion: Moving hand surgery out of the main operating room to minor procedure rooms should be supported by healthcare providers. The higher cost, increased solid waste, and inconvenience of main operating room surgery are not justifiable for many procedures because it does not reduce the risk of postoperative infection.

Introduction : Plusieurs lignes directrices qui sont généralement admises comme représentant les meilleures pratiques en salle d'opération ne reposent pas sur des données probantes. Elles reposent sur le concept que s'il est bon d'avoir un certain degré de stérilité, il doit être encore meilleur d'en avoir plus. Elles ne sont pas tirées de données de stérilité basées sur des données probantes. La stérilité basée sur des données probantes est l'étude cherchant à savoir laquelle de nos diverses pratiques en matière de stérilité augmentent ou diminuent les taux d'infection, par opposition aux lignes directrices basées sur le nombre de bactéries présentes en salle d'opération. Méthodes : Cet article ajoute les données probantes les plus importantes que nous avons pu trouver et qui ne sont pas incluses dans le premier article publié en 2019 sur la stérilité basée des données probantes dans la chirurgie de la main. Dans cette revue, nous mettons aussi dans la balance les données probantes et le bon sens. Résultats : Le 21e siècle a vu un nombre rapidement croissant d'interventions et de rapports de procédures chirurgicales sur la main réalisées avec une stérilité de terrain, en dehors de la salle d'opération principale. Nous disposons aujourd'hui d'une abondance de données probantes de bon niveau indiquant que le taux d'infections n'est pas plus élevé quand de nombreuses opérations de la main sont effectuées avec une stérilité de terrain dans des salles de procédures secondaires. Conclusion : Faire passer la chirurgie de la main hors de la salle d'opération vers des salles de procédures devrait être adopté par les professionnels de santé. Le coût plus élevé, la quantité de déchets et les inconvénients d'un bloc opératoire ne sont pas justifiés pour de nombreuses procédures, car ils ne diminuent pas le risque d'infection postopératoire.

Evaluating the Impact of the Level of Robustness in Operating Room Scheduling Problems.

Managing uncertainty in surgery times presents a critical challenge in operating room (OR) scheduling, as it can have a significant impact on patient care and hospital efficiency. Objectives: By incorporating robustness into the decision-making process, we can provide a more reliable and adaptive solution compared to traditional deterministic approaches. Materials and methods: In this paper, we consider a cardinality-constrained robust optimization model for OR scheduling, addressing uncertain surgery durations. By accounting for patient waiting times, urgency levels and delay penalties in the objective function, our model aims to optimise patient-centred outcomes while ensuring operational resilience. However, to achieve an appropriate balance between resilience and robustness cost, the robustness level must be carefully tuned. In this paper, we conduct a comprehensive analysis of the model's performance, assessing its sensitivity to robustness levels and its ability to handle different uncertainty scenarios. Results: Our results show significant improvements in patient outcomes, including reduced waiting times, fewer missed surgeries and improved prioritisation of urgent cases. Key contributions of this research include an evaluation of the representativeness and performance of the patient-centred objective function, a comprehensive analysis of the impact of robustness parameters on OR scheduling performance, and insights into the impact of different robustness levels. Conclusions: This research offers healthcare providers a pathway to increase operational efficiency, improve patient satisfaction, and mitigate the negative effects of uncertainty in OR scheduling.

Exploring operating room staff engagement in the planning and design of the built environment in Australia: Development of a constructivist grounded theory.

AIM: This study aimed to explore Australian health professionals' perceptions and experiences regarding built environment planning for operating rooms. METHODS: We conducted semi-structured interviews and a focus group using exploratory qualitative methods, involving 16 participants: anaesthetists, surgeons, nurses, theatre technicians and designers of operating rooms. FINDINGS: Four core concerns of participants were analysed: Engagement, Respect & Collaboration; Foreseeing & Responding to Safety Concerns; Enhancing Design Planning to Minimise Internal & External Consequences; and Ambiguous Application of Standards in Operating Room Design Planning. CONCLUSION: Health professionals highlighted safety impacts related to patients and staff due to the built environment and emphasised the need for improved engagement, respect and collaboration in design processes. Consideration needs to be given to the lived experiences of health professionals in design planning to address safety concerns effectively. Hierarchies and cultural factors were identified as barriers to inclusive design processes.

Evaluation of prepectoral reconstruction surgical outcomes: Main operating room vs ambulatory surgery center.

INTRODUCTION: During the height of the recent Coronavirus (COVID-19) pandemic, several surgeries were transitioned to ambulatory surgery centers to reserve inpatient resources and reduce transmission risks. Our study evaluated the surgical outcomes of patients who underwent prepectoral breast reconstruction in the operating rooms of two full-service main hospitals versus their associated surgery centers. METHODS: A retrospective chart review was conducted of patients who underwent immediate prepectoral breast reconstruction at a single hospital between 2018 and 2022. Eligible patients had at least 3 months of post-expander follow-up, with the majority also having 3 months of post-implant follow-up. Patient demographics, reconstructive characteristics, post-expander outcomes, and post-implant outcomes were evaluated between the surgery center and main operating room using the chi-squared (or Fisher's exact) and Wilcoxon ranked-sum tests. RESULTS: This study included 301 patients, outcomes of 509 post-expander breasts, and outcomes of 410 post-implant breasts. The patient characteristics were similar with the only significant difference being the hospital length of stay (increased stay at the main hospital). There were no statistically significant differences in any of the surgical outcomes between the two groups in the post-expander or post-implant period. CONCLUSION: The COVID-19 pandemic disrupted elective procedures, prompting a shift toward outpatient surgery to optimize hospital resources and reduce inpatient exposure risks. Although breast reconstruction is elective, delays can pose risks for patients with cancer. Our results show that surgical outcomes for prepectoral prosthetic breast reconstruction remain consistent whether performed in outpatient surgical centers or main hospitals.

Effect of Hand Grip and Center of Mass Location on Muscle Activity While Manipulating a Surgical Table Segment.

OCCUPATIONAL APPLICATIONSHand grip location relative to the center of mass of an object can impact the activity of trunk and upper limb muscles. Aligning the hand grip location with the center of mass in the anterior/posterior direction minimizes muscle activity. Whether a proximal or distal grip requires more effort appears to be muscle dependent. Our work illustrates how design features influencing hand grip and center of mass location, such as handles and hand-operated mechanisms, can impact the user. Reducing physical effort via design is important to improve usability and help mitigate the high incidence of musculoskeletal injury resulting from manual materials handling tasks.

Background Manual materials handling tasks are associated with a high risk of injury. The physical effort required to lift and manipulate objects can be influenced by design.Purpose Examine the effect of hand grip location and center of mass on physical effort during a surgical table section attachment task.Methods Twelve participants lifted, carried, and placed a table section onto a surgical table. Hand grip and center of mass location of the table section were both modified in three anteroposterior axis directions (proximal, aligned, and distal), as was the mass (6.8, 9.1, and 11.4 kg). Physical effort was quantified as the normalized peak activity from six unilateral trunk and upper limb muscles recorded via surface electromyography.Results As hypothesized, when an effect was present, aligning the hand grip with the center of mass resulted in the lowest level of muscle activity for all muscles. Whether a proximal or distal relationship between hand grip and the center of mass was more arduous differed by muscle: the deltoid, biceps, and extensor digitorum had greater activity with a center of mass located distal to the hand grip, while erector spinae and trapezius muscles had greater activity with a hand grip distal to the center of mass. Flexor digitorum activity was high in both misaligned conditions of hand grip. Mass, as has been previously documented, had a significant and direct effect on all muscle groups.Conclusions This work has implications for design features such as handles, buttons, or release mechanisms that can dictate where the user grips. By quantifying the impact of anteroposterior axis hand grip and center of mass location on the physical demands of manipulating an object, ergonomists and designers can consider the consequences of incorporating features that could misalign the hand grip location and center of mass.

Leading Through Noise: Operating Room Noise Challenges for Staff and Leadership Techniques to Ensure Optimal Operational Performance.

Noise and distractions in the operating room (OR) critically impact surgical performance and patient outcomes, particularly in high-stakes environments such as trauma surgery. While historical hospital environments prioritized quiet to facilitate recovery and reduce stress, contemporary ORs, especially those handling trauma cases, face increasing noise challenges due to advanced surgical instruments, alarms, and staff conversations, often surpassing federal exposure limits. This review investigates OR noise sources, including staff activities and equipment, analyzing their effects on cognitive load, communication, and error rates among healthcare workers. It identifies high-risk scenarios and vulnerable groups, highlighting the necessity for targeted interventions. Key strategies include implementing strict noise control policies, using noise-reducing materials in OR design, and educating staff on noise impacts. Additionally, structured communication protocols and continuous monitoring systems are advocated to enhance operational efficiency and safety. Surgeon leadership is pivotal in balancing assertiveness and empathy to maintain a productive team dynamic. Furthermore, surgeons significantly boost OR efficiency and safety by adopting these protocols, promoting inclusive team dynamics, and applying noise-reduction strategies. These practices safeguard patient care and foster a more collaborative work atmosphere, aligning all team efforts toward optimal patient outcomes. This holistic approach emphasizes the need for continuous improvement and adaptability in surgical practices to meet modern healthcare demands, particularly in trauma surgery's fast-paced, unpredictable realm. Collectively, these measures can enhance patient safety and improve conditions for surgical teams, providing a framework for quieter, more focused OR environments that ultimately elevate surgical outcomes and healthcare quality.

Quantifying the impact of surgical teams on each stage of the operating room process.

Introduction: Operating room (OR) efficiency is a key factor in determining surgical healthcare costs. To enable targeted changes for improving OR efficiency, a comprehensive quantification of the underlying sources of variability contributing to OR efficiency is needed. Previous literature has focused on select stages of the OR process or on aggregate process times influencing efficiency. This study proposes to analyze the OR process in more fine-grained stages to better localize and quantify the impact of important factors. Methods: Data spanning from 2019-2023 were obtained from a surgery center at a large academic hospital. Linear mixed models were developed to quantify the sources of variability in the OR process. The primary factors analyzed in this study included the primary surgeon, responsible anesthesia provider, primary circulating nurse, and procedure type. The OR process was segmented into eight stages that quantify eight process times, e.g., procedure duration and procedure start time delay. Model selection was performed to identify the key factors in each stage and to quantify variability. Results: Procedure type accounted for the most variability in three process times and for 44.2% and 45.5% of variability, respectively, in procedure duration and OR time (defined as the total time the patient spent in the OR). Primary surgeon, however, accounted for the most variability in five of the eight process times and accounted for as much as 21.1% of variability. The primary circulating nurse was also found to be significant for all eight process times. Discussion: The key findings of this study include the following. (1) It is crucial to segment the OR process into smaller, more homogeneous stages to more accurately assess the underlying sources of variability. (2) Variability in the aggregate quantity of OR time appears to mostly reflect the variability in procedure duration, which is a subinterval of OR time. (3) Primary surgeon has a larger effect on OR efficiency than previously reported in the literature and is an important factor throughout the entire OR process. (4) Primary circulating nurse is significant for all stages of the OR process, albeit their effect is small.

The association between surgical complications and compliance to the World Health Organization Surgical Safety Checklist: A retrospective analysis of hospital records.

BACKGROUND: The World Health Organization Surgical Safety Checklist (SSC), now used by healthcare providers worldwide, has proved to be useful in the improvement of patients' health through the reduction of mortality and morbidity after surgery. In the Emilia-Romagna region in Italy the SSC is accompanied by a document that registers any non-conformity (NC) identified during SSC completion. This study aimed to investigate the association between surgical complications and checklist compliance, in terms of incompleteness and presence of NCs, using data from the Modena Local Health Unit (LHU). METHODS: We used data from surgeries performed in the Modena LHU between 2018 and 2022, with their SSC and related NC document. We estimated relative risks (RRs) of complications fitting three modified Poisson regression models. Model 1 included checklist incompleteness and NC presence, Model 2 adjusted Model 1 for patients' sex and age group, and Model 3 adjusted Model 2 for the other potential confounders. We also performed a sensitivity analysis estimating the same three models including death outcomes as complications. RESULTS: We found an increased risk of complications for both checklist incompleteness (unadjusted RR [uRR]= 2.04; 95% confidence interval [CI]: 1.17 to 3.54) and presence of NCs (uRR = 2.35; 95% CI: 1.71 to 3.22). Results were consistent after adjustment and in the sensitivity analysis. CONCLUSIONS: Improving checklist compliance can reduce the risk of surgical complications. In particular, NCs are a risk factor that must be further investigated to better understand their relationship with complications. We believe that NCs data recording is helpful for both researchers in the scope of surgical complications, and healthcare professionals in the operating room.

Exploring the need for surgical face masks in operating room: a comprehensive literature review.

Surgical face masks (SFM) are pivotal in preventing surgical site infections (SSI) in the operating room (OR). However, there are currently no specific recommendations for their most effective use. SFM effectiveness is influenced by factors such as material, fit, and duration of use, sparking ongoing debates about their benefits and risks in surgery. SFMs act as a protective barrier, but their ability to filter out harmful compounds is questioned. They can also impact communication and create a false sense of security. Nevertheless, SFMs aid in infection prevention and provide psychological comfort. Clear guidelines are needed to ensure their appropriate use in the OR. This paper offers a historical overview of surgical masks, emphasizing their role in infection prevention. It explores SFM effectiveness for both the surgical team and patients during surgery and considers their future in surgical settings. As we navigate the evolving landscape of SFMs, clear and concise guidelines are imperative to ensure their judicious and effective use in the OR. This paper serves as an essential resource for understanding the historical significance, contemporary efficacy, and prospective trajectory of SFMs in surgical practice.

Investigating the effect of video-based training on adherence of surgical positioning standards: a randomized controlled trial.

BACKGROUND: The operating room is a high-risk environment where proper patient positioning is crucial for minimizing injury and ensuring optimal access to surgical sites. This process requires effective collaboration among surgical team members, particularly operating room nurses who play a vital role in patient safety. Despite advancements in technology, challenges such as pressure injuries persist, with a significant incidence rate. Video-based training (VBT) emerges as a promising educational tool, enhancing knowledge retention and fostering a learner-centered approach. This study aims to evaluate the impact of VBT on adherence to surgical positioning standards, highlighting its potential to improve safety protocols in the operating room. METHODS: In this clinical trial, 62 qualified operating room nurses (50 women, 12 men, average age: 28.90 ± 3.75 years) were randomly divided into control and intervention group (n = 31 in each group). The control group only received positioning recommendations, but in the intervention group, in addition to the recommendations, video-based surgical positioning training was performed for 1 month, at least 3 times a week. The performance of nurses in both groups was evaluated through a researcher-made checklist at baseline and post-intervention. RESULTS: Based on findings, there was no significant difference between the two groups in compliance with surgical positioning standards at baseline (p = 0.07). However, after the intervention, compliance scores significantly improved in the VBT group compared to the control group (p < 0.001). The VBT group showed a mean improvement of 62.12 points, while the control group improved by 10.77 points (p < 0.001). CONCLUSIONS: This preliminary study demonstrated a notable improvement in compliance with surgical positioning standards among operating room nurses following VBT intervention. Despite the promising results, the small sample size and preliminary nature of the research necessitate further studies to confirm these findings and assess long-term outcomes. These initial insights highlight the potential of innovative training methods in enhancing surgical practices.

The impact of spinal versus general anesthesia on the variability of surgical times: a systematic review and meta-analysis.

BACKGROUND: With spinal anesthesia, when cases are taking longer than usual, there may be behavioural tendencies for surgical teams to work more quickly. We conducted a systematic review with meta-analysis to examine standard deviations of surgical times for single-dose spinal anesthetics versus general anesthesia. We compared ratios of mean surgical times as a secondary endpoint. METHODS: We included randomized trials of humans where general or spinal anesthesia was used for one category of surgical procedure (e.g., hip arthroplasty) and the article reported the means and standard deviations of operative durations. We used statistical methods suitable for surgical times following log-normal distributions. We used generalized confidence intervals to calculate point estimates of ratios and standard errors for each study, followed by pooling among studies using DerSimonian and Laird random-effects meta-analysis with Knapp-Hartung adjustment. RESULTS: Among the 77 included studies, 96% were of high quality for our endpoint (i.e., had a low risk of bias), as no (0%) study focused on comparing variability of surgical times and none had surgical time as the primary endpoint. Spinal anesthesia was associated with 6.6% smaller standard deviations than general anesthesia (95% confidence interval, 15.8% smaller to 1.9% larger, P = 0.13). By meta-regression, there was no significant association of the ratios of standard deviations with study quality (P = 0.39), year of publication (P = 0.76), or categories of procedures (all five P ≥ 0.28). Spinal anesthesia was associated with 1.1% smaller means than general anesthesia (95% confidence interval, 3.7% smaller to 1.5% larger, P = 0.42). There were no significant associations between the ratios of means and study quality (P = 0.47), year of publication (P = 0.95), or categories of procedures (all five, P ≥ 0.63). CONCLUSIONS: The results of this systematic review and meta-analysis show with high confidence that the effect of choosing spinal anesthesia on variability in surgical time, if present, is sufficiently small to have no substantive direct economic effect. The same conclusion applies to mean surgical time. Therefore, although anesthetic choice has a clinical (biological) impact and affects anesthesia times, the direct effects on surgical times and workflow are minimal at most. Anesthetic choice does not influence operating theatre productivity via changes to surgical times. The impact of spinal anesthetic effects is limited to nonoperative times (e.g., reducing anesthesia-controlled times by using a block room before the patient enters the operating room). STUDY REGISTRATION: PROSPERO ( CRD42023461952 ); first submitted 8 September 2023.

RéSUMé: CONTEXTE: Lors de l'utilisation de rachianesthésie, si les cas prennent plus de temps que d'habitude, les équipes chirurgicales pourraient avoir tendance à travailler plus rapidement. Nous avons réalisé une revue systématique avec méta-analyse pour examiner les écarts types des temps chirurgicaux pour les rachianesthésies en dose unique par rapport à l'anesthésie générale. Nous avons comparé les rapports des durées chirurgicales moyennes comme critère d'évaluation secondaire. MéTHODE: Nous avons inclus des études randomisées chez l'humain dans lesquelles l'anesthésie générale ou rachidienne avait été utilisée pour une catégorie d'intervention chirurgicale (par exemple, l'arthroplastie de la hanche) et pour lesquelles les moyennes et les écarts types des durées opératoires étaient rapportés. Nous avons utilisé des méthodes statistiques adaptées aux temps chirurgicaux suivant des distributions log-normales. Nous avons utilisé des intervalles de confiance généralisés pour calculer des estimations ponctuelles des ratios et des erreurs-types pour chaque étude, suivis d'un regroupement entre les études à l'aide d'une méta-analyse à effets aléatoires de DerSimonian et Laird avec ajustement de Knapp-Hartung. RéSULTATS: Parmi les 77 études incluses, 96 % étaient de haute qualité pour notre critère d'évaluation (c'est-à-dire qu'elles présentaient un faible risque de biais), car aucune étude (0 %) ne s'est concentrée sur la comparaison de la variabilité des temps chirurgicaux et aucune n'avait le temps chirurgical comme critère d'évaluation principal. La rachianesthésie était associée à des écarts types inférieurs de 6,6 % à ceux de l'anesthésie générale (intervalle de confiance à 95 %, 15,8 % plus petit à 1,9 % plus grand, P = 0,13). Par métarégression, il n'y avait pas d'association significative entre les ratios des écarts types et la qualité de l'étude (P = 0,39), l'année de publication (P = 0,76), ou des catégories de procédures (les cinq P ≥ 0,28). La rachianesthésie était associée à des moyennes inférieures de 1,1 % à celles de l'anesthésie générale (intervalle de confiance à 95 %, 3,7 % plus petit à 1,5 % plus grand, P = 0,42). Il n'y a pas eu d'association significative entre les ratios des moyennes et la qualité des études (P = 0,47), l'année de publication (P = 0,95), ou les catégories de procédures (toutes les cinq, P ≥ 0,63). CONCLUSION: Les résultats de cette revue systématique et de cette méta-analyse montrent avec un degré de confiance élevé que l'effet du choix de la rachianesthésie sur la variabilité du temps chirurgical, le cas échéant, est suffisamment faible pour n'avoir aucun effet économique direct substantiel. La même conclusion s'applique au temps chirurgical moyen. Par conséquent, bien que le choix de l'anesthésie ait un impact clinique (biologique) et affecte les temps d'anesthésie, les effets directs sur les temps chirurgicaux et le flux de travail sont tout au plus minimes. Le choix du type d'anesthésie n'influence pas la productivité de la salle d'opération en modifiant les temps chirurgicaux. L'impact des effets de la rachianesthésie est limité aux périodes non opératoires (p. ex., réduire les temps de contrôle de l'anesthésie en utilisant une salle de bloc avant que le patient ou la patiente n'entre en salle d'opération). ENREGISTREMENT DE L'éTUDE: PROSPERO ( CRD42023461952 ); première soumission le 8 septembre 2023.