Adverse Events Associated With Disparity Between Patients' BMI and Operating Table Size-A Need for Improved Surgical Innovations.

BACKGROUND: The lack of proper equipment to accommodate patients with high BMI can jeopardize the safety of the patients and medical staff. In this review, we aim to discuss the availability of obesity accommodations in the operating room, along with its impact, implications, and future recommendations. METHODS: Four databases were searched for articles pertaining to surgical table dimensions and the implications for safety, with a special focus on patients with larger BMIs. Articles were separated into 4 categories: Existing OR Table Options, Safety Implications for Patients, Reported Adverse Events Associated with Operating Table Inadequacy, and Safety Implications for Medical Staff. RESULTS: A total of 18 articles and documents were included in this review. Most of the literature that discusses surgical tables with higher weight capacity is specific only to weight loss surgeries. Operating table dimensions have changed little in the past 100 years and standard operating tables have weight limits of 500 pounds. Several case reports underline the hazards of inadequately sized surgical tables. CONCLUSIONS: This review demonstrates that a lack of proper equipment, such as surgical tables with adequate width and weight limits, can be a major contributor to the endangerment of bariatric surgical patients and the medical professionals who care for them. Further research and surgical innovation may be required to develop superior operating tables to address the unique concerns of this patient populations.

An ergonomic assessment of using laterally-tilting operating room tables and friction reducing devices for patient lateral transfers.

Patient lateral transfers between two adjacent surfaces pose high musculoskeletal disorder risks for nurses and patient handlers. The purpose of this research was to examine the ergonomic benefits of utilizing the laterally-tilting function of operating room (OR) tables during such transfers - along with different friction-reducing devices (FRD). This method allows the patient to slide down to the adjacent surface as one nurse guides the transfer and another controls the OR table angle with a remote control. Sixteen nursing students and sixteen college students were recruited to act as nurses and patients, respectively. Two OR table angles were examined: flat and tilted. Three FRD conditions were considered: a standard blanket sheet, a plastic bag, and a slide board. Electromyography (EMG) activities were measured bilaterally from the posterior deltoids, upper trapezii, latissimus dorsi, and lumbar erector spinae muscles. The Borg-CR10 scale was used for participants to rate their perceived physical exertions. The efficiency of each method was measured using a stopwatch. Results showed that the tilted table technique completely replaced the physical efforts that would have been exerted by the pushing-nurse, in that muscle activation did not increase in the pulling-nurse. On the contrary, EMG activities of the pulling-nurse for most of the muscles significantly decreased (p < 0.05). The subjective Borg-ratings also favored the tilted table with significantly lower ratings. However, the tilted table required on average 7.22 s more than the flat table to complete the transfer (p < 0.05). The slide board and plastic bag were associated with significantly lower Borg-ratings and EMG activities for most muscles than blanket sheet, but they both were not significantly different from each other. However, they each required approximately 5 s more than the blanket sheet method to complete the patient transfer (p < 0.05). By switching from flat + blanket sheet to tilted + slide board, EMG activities in all muscles decreased in the range of 18.4-72.3%, and Borg-ratings decreased from about 4 (somewhat difficult) to 1 (very light). The findings of this study propose simple, readily available ergonomic interventions for performing patient lateral transfers that can have significant implications for nurses' wellbeing and efficiency.

Control inalámbrico de mesa quirúrgica desde dispositivo móvil / Wireless control of operating tables from a mobile device

Para la mayoría de las mesas quirúrgicas del hospital, el proveedor ya no comercializa controles remotos compatibles, lo cual implicaría un gasto importante para su actualización o renovación. Para evitar dicho gasto, se diseñó un control inalámbrico para manejar los movimientos de las mesas quirúrgicas a través de un dispositivo móvil.

The provider no longer provides compatible remote controls for most of operating tables at the hospital, which would imply an important expense for their upgrading or renewal. In order to avoid that expenditure, a wireless control was designed to improve operating table movements from a mobile device.

Safety of Electro-Medical Equipment in Floods in Austere Environment.

Pakistan is prone to floods. In 2010, floods in North-Western Pakistan caused devastation in wide areas. Electro-medical equipment is very expensive and without proper equipment adequate surgery is not possible. We retrospectively analyzed how expensive electro-medical equipment got damaged during floods of 2010 at a district-level hospital in North-Western Pakistan and how we could have saved this equipment or reduced the damage to the minimum. The article provides the lessons learned and recommendations aimed to prevent or minimize damage to the valuable and expensive equipment in the areas prone to floods. (Disaster Med Public Health Preparedness. 2018;12:803-805).

Preventing falls in the operating room: a technique tip for safely tilting the operating table.

BACKGROUND: Many articles have been published to address the topic of in-hospital falls; however, there is considerably less literature that focuses specifically on the topic of falls from the operating room table. The lay press and legal filings contain reports of such incidents, which can result in considerable morbidity, lawsuits, and occasional death. TECHNIQUE: When tilting the operating table, a simple technique for preventing falls is through the use of posts. Posts are regularly used during knee and hip arthroscopy to facilitate valgus positioning or access into the joint. These posts can be positioned below the axilla and at the level of the greater trochanter to supplement patient safety straps when tilting the table. DISCUSSION: Falls that occur during a hospital admission can lead to serious injury and prolonged hospital stays. Furthermore, falls that occur off the operating table are particularly disastrous and in some cases have resulted in death. Our proposed technique is simple and particularly useful for patients with large or small body habitus or when operating procedures necessitate significant tilting of the operating table. LEVELS OF EVIDENCE: Level V.

Support surfaces for intraoperative prevention of pressure ulcers in patients undergoing surgery: a cost-effectiveness analysis.

BACKGROUND: Patients who undergo prolonged surgical procedures are at risk of developing pressure ulcers. Recent systematic reviews suggest that pressure redistribution overlays on operating tables significantly decrease the associated risk. Little is known about the cost effectiveness of using these overlays in a prevention program for surgical patients. METHODS: Using a Markov cohort model, we evaluated the cost effectiveness of an intraoperative prevention strategy with operating table overlays made of dry, viscoelastic polymer from the perspective of a health care payer over a 1-year period. We simulated patients undergoing scheduled surgical procedures lasting ≥90 min in the supine or lithotomy position. RESULTS: Compared with the current practice of using standard mattresses on operating tables, the intraoperative prevention strategy decreased the estimated intraoperative incidence of pressure ulcers by 0.51%, corresponding to a number-needed-to-treat of 196 patients. The average cost of using the operating table overlay was $1.66 per patient. Compared with current practice, this intraoperative prevention strategy would increase slightly the quality-adjusted life days of patients and by decreasing the incidence of pressure ulcers, this strategy would decrease both hospital and home care costs for treating fewer pressure ulcers originated intraoperatively. The cost savings was $46 per patient, which ranged from $13 to $116 by different surgical populations. Intraoperative prevention was 99% likely to be more cost effective than the current practice. CONCLUSION: In patients who undergo scheduled surgical procedures lasting ≥90 min, this intraoperative prevention strategy could improve patients' health and save hospital costs. The clinical and economic evidence support the implementation of this prevention strategy in settings where it has yet to become current practice.

1993 Federal Nursing Service Award recipient. Use of air-filled pads to reduce risk of intraoperatively acquired pressure ulcers.

This descriptive study utilized a two-phased retrospective review of medical records to investigate the development of pressure ulcers during cardiothoracic or vascular surgery. Using descriptive and chi-square statistics, the charts of 104 patients having surgery on standard table pads were compared with those of 124 patients having similar surgical procedures while positioned on air pads. Eight (8%) of the patients who had surgery without an air pad developed pressure ulcers, while none (0%) of the patients who were positioned on air pads developed pressure ulcers. Six (75%) of the eight patients who developed pressure ulcers were diabetic.