The effects of surgical checklists on morbidity and mortality: a pre- and post-intervention study.

BACKGROUND: Surgical checklists (SCs) have been developed to enhance teamwork and facilitate handovers, thereby improving the safety of surgical patients in health care organisations. The aim of this study was to determine whether the implementation of a 39-item SC reduced mortality and surgical adverse events (AEs) in patients undergoing inpatient surgery. METHODS: A retrospective pre- and post-intervention study of two cohorts of surgical patients was conducted (n = 1602) in a tertiary teaching hospital. The patients' homogeneity was confirmed by studying 40 comorbidities, 13 analytical determinations and 14 patient- and intervention-related variables. A 39-item SC adapted from one by the World Health Organization was used. The primary endpoint was the occurrence of any AE, including death, within 30 days of the operation. Twenty-three types of AEs were analysed. RESULTS: Following implementation of the checklist, the rate of AEs per 100 patients decreased from 31.5% to 26.5% (P = 0.39), the rate of infectious AEs decreased from 13.9 to 9.6 (P = 0.037) and non-infectious AEs decreased from 17.5 to 16.8 (P = 0.82). For non-elective patients, total AEs decreased from 60.4 to 37.0 (P = 0.017). The proportion of patients with one or more AE decreased from 18.1% to 16.2% (P = 0.35), and the death rate at 30 days decreased from 1.5% to 0.9% (P = 0.35). CONCLUSION: The overall AE rate did not decrease significantly between the two periods. However, the rate of infectious AEs and overall AEs in patients with non-elective admissions had statistically significant reductions. Further research is needed to determine how and in which patients SC introduction can work successfully.

[Comparison between VAMA(®) and Berman(®) cannulas for fibroscopic orotracheal intubation in anaesthetised patients]. / Comparación de las cánulas VAMA(®) y Berman(®) para la intubación fibroscópica orotraqueal en pacientes anestesiados.

OBJECTIVES: In fibroscopic intubation, the fact of achieving a direct view in real time does not guarantee the correct advance of the endotracheal tube (ET) to its intratracheal position. The use of oral cannulas helps in achieving a free airway in order to pass the fibroscope and the ET. This study compares the VAMA(®) (V) and Berman(®) (B) cannulas as regards the time required for the intubation, fibroscopic view, and the ease in positioning the ET. PATIENTS AND METHODS: 90 patients with no signs of difficult airway were randomised into 2 groups, Berman(®) (B) and VAMA(®) (V), depending on the type of cannula employed. After inducing general anaesthesia, they were intubated using a flexible fibroscope. The fibroscope and intubation times were recorded, as well as the quality of the fibroscopic view, and the level of difficulty in positioning the ET. RESULTS: No statistically significant differences were observed between the cannulas, although the intubation time (P=.292) and the difficulty found in positioning the ET were slightly less (P=.447) in the VAMA(®) group compared to the Berman(®) group. The vision quality was good with both devices, with only some degree of obstruction being encountered in only 22% of the patients. In no case was there complete obstruction, thus all the patients could be intubated correctly. CONCLUSIONS: The VAMA(®) cannula is an effective alternative to the classic cannulas for fibreoptic assisted intubation. Furthermore, the novel design provides advantages for the correct orientation of the fiberscope and the withdrawal of the cannula after intubation.

[Orotracheal intubation of patients with acromegaly using the AirTraq laryngoscope]. / Intubación orotraqueal con laringoscopio óptico Airtraq en pacientes acromegálicos.

An excess of growth hormone is responsible for the phenotypical characteristics of acromegaly. Tissue hypertrophy and growth also affect the airway, potentially making perioperative management difficult. If tests to foresee the likelihood of difficult airway have limitations affecting their sensitivity, specificity and predictive value even in the normal population, their reliability in patients with acromegaly is still more doubtful. At this time, videoassisted or optical laryngoscopes can offer a way to facilitate intubation in these patients. We report 3 cases in which the AirTraq optical laryngoscope was used to gain a full view of the vocal cords in acromegalic patients scheduled for pituitary surgery by the transsphenoidal route.

[The healthcare professional's perceptions on the implementation and usefulness of the surgical safety checklist]. / Percepción de los profesionales sobre la utilización y la utilidad del listado de verificación quirúrgica.

OBJECTIVE: To find out the perception of the health care professionals on the level of implementation and the usefulness of the surgical safety checklist (LVQ) after its introduction in a tertiary care hospital. MATERIAL AND METHOD: A descriptive cross-sectional study was conducted using a specially designed self-completion questionnaire. This consisted of 5 questions on the usefulness, 5 questions on the use of the LVQ, one open question and 4 control questions. The target population was hospital surgeons, anaesthetists, ward nurses, and surgical nurses. RESULTS: The response rate was 73%, ranking from 51% to 88% depending on the respondent profile. Almost all (95.7%) of the respondents declared they always or almost always used the LVQ when performing a surgical operation. The health care professionals rated the usefulness of the LVQ with a mean of 6.6 (scale, 1-10); 11.6% mentioned that actual errors had been avoided through the use of the LVQ; 32.5% considered the LVQ as a tool that improves communication between professionals; and 68% of the respondents declared they would like the LVQ to be used if they were surgical patients. Those respondents who answered that the LVQ had prevented errors gave higher usefulness scores, 1.4 above the mean. In this same group, 100% of the respondents would like the LVQ to be used on themselves and 63.2% considered that communication had improved. There were no differences in usefulness scores as regards professional experience or gender. CONCLUSIONS: The health care professionals use the LVQ very frequently, and consider that it has a moderate usefulness. Those professionals with experience of the LVQ preventing errors considered it to be more useful than those who did not experience an error being prevented.

Health status and health-related quality of life in survivors of cancer in childhood in Latin America: a MISPHO feasibility study.

Cancer is an increasing cause of disease-related death in childhood within developing countries, where the great majority of the world's children reside. The improving prospects for survival in such children, and the corresponding challenge of undertaking economic evaluations of related health interventions, provide a stimulus to study the health-status and health-related quality of life in survivors of cancer in childhood in Latin America. Spanish language versions of questionnaires for proxy assessors, based on the Health Utilities Index (HUI), were used to elicit responses from parents and physicians. The HUI is a family of multi-attribute, generic, preference-linked measures of health status and health-related quality of life that are reliable, responsive and valid, and have been used previously in pediatric oncology. Valid responses were received from 178 parents and 144 physicians in 6 centres in 4 countries (Cuba, Honduras, Colombia and Uruguay). For children with acute lymphoblastic leukemia the major morbidity burdens were in the attributes of emotion, cognition and pain. The overall burden of morbidity was greater in children with non-Hodgkin's lymphoma. In survivors of Hodgkin's disease and Wilms' tumor the attributes most affected were emotion and pain. In general, there was considerable agreement between the assessments provided independently by parents and physicians. This study demonstrates the feasibility of conducting such measurements in developing countries, and reveals similarities in health status and health-related quality of life to comparable populations in more privileged societies.