Patient Safety in Surgery最新文献

{"title":"Postoperative anaesthesia follow-up via telemedicine after outpatient surgery: a proof-of-concept study.","authors":"Benedikt Ludwig Huerter, Rolf Rossaint, Jan Larmann, Michael Czaplik, Andreas Follmann","doi":"10.1186/s13037-026-00514-x","DOIUrl":"https://doi.org/10.1186/s13037-026-00514-x","url":null,"abstract":"<p><strong>Background: </strong>Postoperative anaesthesia visits after inpatient procedures guarantee a comprehensive assessment of the patient's status. As the number of outpatient surgical cases in hospitals increases, more patients are recovering at home. Telemedicine may provide an efficient and effective link between anaesthesiologists and patients at home without restricting their freedom and self-determination.</p><p><strong>Methods: </strong>After an initial acceptance survey, a single-arm, observational pilot study piloted an optional postoperative anaesthesia visit for patients undergoing outpatient surgery under general anaesthesia. It was implemented using videochats and patient-reported outcome measure (PROM) questionnaires.</p><p><strong>Results: </strong>Of the 300 people initially surveyed in the initial acceptance survey, nearly two-thirds (62.0%) expressed interest in using videochats to contact an anaesthesiologist after discharge. One hundred patients (n = 100) were included in the subsequent observational pilot study. The offer of an optional postoperative visit was used by 65 participants (n = 65, 65%). Videochats were considered a reliable tool for communicating medical issues and perceived as superior to telephone calls. The use of PROM questionnaires was considered meaningful by more than 80% of participants. Sixty-two of the sixty-five participants considered the postoperative anaesthesia visit a useful and beneficial part of the treatment and recovery process.</p><p><strong>Conclusions: </strong>Postoperative anaesthesia visits via videochat combined with PROM questionnaires after outpatient surgery were successfully piloted and consistently perceived positively by participants. Telemedicine-assisted postoperative anaesthesia visits may be a feasible component of patient-centred care in settings with limited resources.</p><p><strong>Trial registration: </strong>German Clinical Trials Register; https://drks.de/search/en; registration number: DRKS00028755, registration date: 26th January 2023.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"20 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repurposing a commercial artificial intelligence vision platform for automated surgical instrument identification: a proof-of-concept study.","authors":"Simon Stoerzer, Klinto Xhemo, Felix Gronau, Linda Feldbruegge, Philipp Felgendreff, Maximilian Kaltenecker, Jacques Hahn, Gerrit Grannas, Moritz Schmelzle","doi":"10.1186/s13037-026-00512-z","DOIUrl":"https://doi.org/10.1186/s13037-026-00512-z","url":null,"abstract":"<p><strong>Background: </strong>Retained surgical items are classified as never events but continue to occur, and the count meant to prevent them is often recorded as correct even when an item is retained. Computer vision could provide an independent check on what is on the instrument table, but purpose-built surgical systems are scarce. Industrial vision platforms offer a faster route, although their surgical performance is unknown.</p><p><strong>Methods: </strong>In a prospective experimental study, a commercial artificial intelligence vision platform developed for industrial inspection was applied to 19 surgical instruments and 3 suture items, each presented once in 100 runs (2,200 experiments). No software redesign was required, but the classifier had been trained on this item set, making this a supervised rather than a zero-shot setting. Two outcomes were recorded: whether the platform assigned the exact item identity, and whether it registered an item as present at the packing step irrespective of type, termed count-presence detection. Because experiments are clustered within items and runs, the primary estimate is the mean per-item accuracy with cluster-adjusted intervals.</p><p><strong>Results: </strong>The correct instruments were identified in 2,036 of 2,200 experiments (92.5%). The mean per-item accuracy was 92.5% (95% confidence interval 88.4 to 96.7; cluster-adjusted 87.7 to 95.6). Count-presence detection was 99.1% (98.7 to 99.4). Performance was reproducible across runs (intraclass correlation 0.02), whereas variance clustered by item (0.12). Accuracy ranged from 64% (suture needle 6-0) to 100% (six items). Errors were directional and almost always within visually near-identical sub-types.</p><p><strong>Conclusions: </strong>An industrial vision platform detected item presence with high reliability and identified item type with high accuracy, however, with a residual error rate of 7.5%. The errors were predictable and confined to visually similar classes, pointing to correctable mitigations rather than a fundamental limit. These figures represent an upper bound under highly controlled conditions rather than expected intraoperative performance. Such a system is intended to support rather than replace the perioperative team. This study establishes feasibility rather than clinical benefit; a prospective intraoperative study is the necessary next step.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"20 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Implementation of audiovisual recording in the operating room: a nationwide survey of stakeholder perspectives in France.","authors":"Côme Slosse, Arnaud Allemang-Trivalle, Nicolas El Haïk-Wagner, Amandine Luc, Elodie Jeanbert, Eric Vibert, Hervé Bouaziz","doi":"10.1186/s13037-026-00507-w","DOIUrl":"10.1186/s13037-026-00507-w","url":null,"abstract":"","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"20 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The silent normalization of biological exposures in operating rooms: an overlooked occupational crisis.","authors":"Majid Bagheri","doi":"10.1186/s13037-026-00509-8","DOIUrl":"10.1186/s13037-026-00509-8","url":null,"abstract":"<p><p>Operating room personnel are exposed to biological hazards such as needlestick injuries and blood and body fluid exposure, which pose risks of bloodborne infections. However, many of these incidents remain unreported. Underreporting is driven by normalization of exposure, fear of blame, workload, and limited knowledge of reporting procedures. This leads to underestimation of occupational risk and weakens prevention strategies. Improving reporting systems, education, and institutional support is essential to enhance occupational safety in perioperative settings.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"20 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Necessary teaching or preventable disruption? Reconsidering resident trainee-related workflow interruptions in academic operating rooms.","authors":"Amirali Alizadeh","doi":"10.1186/s13037-026-00503-0","DOIUrl":"10.1186/s13037-026-00503-0","url":null,"abstract":"","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"20 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13401278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relevance of leukocytosis in patients with severe trauma: a systematic review.","authors":"Christian Thomas Hübner, Puk van Wagenveld, Felix Karl-Ludwig Klingebiel, Yannik Kalbas, Sascha Halvachizadeh, Roman Pfeifer, Hans-Christoph Pape, Michel Paul Johan Teuben","doi":"10.1186/s13037-026-00504-z","DOIUrl":"https://doi.org/10.1186/s13037-026-00504-z","url":null,"abstract":"<p><strong>Background: </strong>Polytrauma remains a leading cause of death in individuals younger than 40 years and poses major challenges during early resuscitation and subsequent clinical management. Beyond early mortality from hemorrhage, post-traumatic inflammatory and infectious complications such as systemic inflammatory response syndrome (SIRS), acute respiratory distress syndrome (ARDS), and multiple organ dysfunction syndrome (MODS) are of increasing clinical relevance. Leukocyte count is a simple and routinely available laboratory parameter. This systematic review aimed to evaluate whether leukocyte count on admission is associated with post-traumatic complications and mortality.</p><p><strong>Methods: </strong>A systematic review in accordance with the PRISMA guidelines was conducted. PubMed/MEDLINE and EMBASE were systematically searched for original English-language clinical studies published between January 1, 2000, and July 31, 2025, that investigated leukocyte counts following adult polytrauma. After deduplication, 2,169 records were independently screened by three investigators based on titles and abstracts. Thirty-two reports were sought for retrieval, and 12 studies were finally included. Disagreements were resolved by consensus. Data on study characteristics, patient and injury characteristics, leukocyte counts and kinetics, and clinical outcomes were extracted and qualitatively synthesized. Study quality and risk of bias were assessed using the Newcastle-Ottawa Scale. A sample-size-weighted mean admission leukocyte count was calculated from the reported study-level means, and associations were analyzed using Spearman's rank correlation.</p><p><strong>Results: </strong>After subsequent screening 12 studies with overall 15,658 patients were finally included in the current review. Across all studies, leukocyte counts after trauma were elevated compared with reference values. The weighted mean leukocyte count across studies was 10.26 × 10^9/L. The proportion of blunt trauma was positively correlated with mean leukocyte count (rho = 0.775, p = 0.04). Pneumonia and SIRS were reported in three and four studies, respectively. One study reported higher mortality in patients with persistent leukocytosis after trauma.</p><p><strong>Conclusions: </strong>This review demonstrates that leukocyte counts are consistently elevated following trauma. Although some studies suggested associations with morbidity and mortality, the available evidence remains insufficient for firm prognostic conclusions because of substantial heterogeneity and the predominantly retrospective design of the included studies. Further research should focus on leukocyte subpopulations, particularly neutrophils, to improve understanding of post-traumatic immune responses and their clinical relevance.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"20 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new mathematical analysis of randomized trials applied to critical care syndromes: a review.","authors":"Lawrence Lynn","doi":"10.1186/s13037-026-00499-7","DOIUrl":"10.1186/s13037-026-00499-7","url":null,"abstract":"<p><p>Guideline reversals and reversals of randomized controlled trial (RCT) treatment effect estimates have been repeatedly documented in critical care syndrome research over several decades. Critical care syndrome RCTs differ structurally from conventional disease-based RCTs. Rather than enrolling patients on the basis of a specific disease or causal mechanism, they typically employ consensus-derived eligibility criteria composed of disease-and cause-agnostic prognostic physiological thresholds, laboratory abnormalities, and/or nonspecific clinical features. These enrollment criteria select a heterogeneous mixture of distinct diseases and causal systems which are mixed into a single trial. Consequently, the resulting treatment-effect estimate is not the average treatment effect of a single disease or causal mechanism. Instead, it represents a second-order average: an overall average generated by averaging disease or causal system-specific average treatment effects across multiple distinct causal systems. The resulting estimate is therefore best understood as an artefactual \"mean of causally unrelated means\": a mixture-weighted average of different treatment effects arising from biologically distinct disease processes. The proposed framework implies that the prevalent structure may produce unstable effect estimates and a \"cause-mixture paradox,\" in which observed treatment effects reverse to the null or opposite sign across trials as the disease mixture of each trial shifts. This framework comprises a new tool for the mathematical assessment of evidentiary strength of critical care trials under guideline consideration.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of the harmonic scalpel versus conventional \"clamp-and-tie\" approach for intraoperative bleeding control during thyroidectomy: a surgeon's experience in 60 consecutive cases.","authors":"Soniya Shankar Kalpana, G Tilak Ramu, Balaji Durairaj","doi":"10.1186/s13037-026-00501-2","DOIUrl":"10.1186/s13037-026-00501-2","url":null,"abstract":"<p><strong>Background: </strong>Post-thyroidectomy complications including hypocalcemia, recurrent laryngeal nerve injury, and cervical hematoma remain important safety concerns. Although the harmonic scalpel improves operative efficiency, evidence regarding its impact on patient safety outcomes remains limited.</p><p><strong>Methods: </strong>In this prospective observational cohort study, 60 patients undergoing open thyroidectomy were allocated to harmonic scalpel (n = 30) or clamp and tie (n = 30) groups. The primary endpoints were safety outcomes, including hypocalcemia, recurrent laryngeal nerve injury, postoperative hematoma, surgical site infection, and composite complication rates. Secondary endpoints included operative time, intraoperative blood loss, drain output, postoperative pain, and length of hospital stay. Statistical significance was defined as p < 0.05.</p><p><strong>Results: </strong>Use of the harmonic scalpel was associated with a significant reduction in overall complications compared with the conventional technique (13.3% vs. 33.3%, p = 0.04). Transient hypocalcemia occurred less frequently in the harmonic scalpel group, accompanied by significantly higher postoperative calcium levels at 24 and 48 h. No recurrent laryngeal nerve injury or postoperative hematoma was observed in the harmonic scalpel group, although differences were not statistically significant. In addition to improved safety outcomes, harmonic scalpel use resulted in shorter operative duration, substantially reduced intraoperative blood loss, lower postoperative drain volumes, decreased pain scores, and reduced length of hospital stay.</p><p><strong>Conclusion: </strong>The harmonic scalpel was associated with improved operative efficiency and a lower overall complication burden without increasing major safety-related complications. Larger randomized multicenter studies are required to confirm these findings.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"The Critical 18\" of postoperative white blood cell count and C-reactive protein level predicts postoperative pancreatic fistula after distal pancreatectomy.","authors":"Ughur Aghamaliyev, Athanasios Zamparas, Stefanie Jarmusch, Gwendolin Seidel, Felix O Hofmann, Gulnar Jafarova, Yannick Meyer, Simon Sirtl, Hanno Niess, Javad Karimbayli, Jens Werner, Bernhard W Renz","doi":"10.1186/s13037-026-00497-9","DOIUrl":"10.1186/s13037-026-00497-9","url":null,"abstract":"<p><strong>Background: </strong>Distal pancreatectomy (DP) carries high risk for postoperative pancreatic fistula. This study evaluates white blood cell count (WBC), C-reactive protein (CRP) and interleukin-6 (IL-6) as serum-based predictors, offering potential alternatives to drain amylase for early pancreatic fistula diagnosis.</p><p><strong>Methods: </strong>This retrospective cohort study included adult patients who underwent elective distal pancreatectomy between 01/2014 and 12/2023. Inclusion criteria required the availability of WBC count and CRP levels during the first three postoperative days. Exclusions were prior pancreatic surgery, combined DP/enucleation, or missing data. Data collected included demographics, comorbidities, intraoperative details, and postoperative serum markers (WBC, CRP, IL-6) from postoperative day 1 to postoperative day 3.</p><p><strong>Results: </strong>This study included 210 patients who underwent distal pancreatectomy and met all inclusion criteria. Median WBC counts were significantly higher in patients with pancreatic fistula, especially on postoperative day 2 (18.5 × 10⁹/L vs. 16.0 × 10⁹/L, p < 0,01). CRP levels peaked higher in the pancreatic fistula group on postoperative day 3 (19.8 mg/dL vs. 15.3 mg/dL, p < 0.001). IL-6 levels showed no significant difference. Receiver Operating Characteristic (ROC) analysis identified WBC on postoperative day 2 (AUC = 0.62) and CRP on postoperative day 3 (AUC = 0.65) as relevant predictors, with optimal cut-off values of 17.9 × 10⁹/L and 17.2 mg/dL, respectively, which were rounded to 18. The combined elevation of both markers, defined as the \"Critical 18\" was associated with a markedly higher pancreatic fistula rate (59% vs. 18% in patients without elevation of either marker).</p><p><strong>Conclusions: </strong>In light of these findings, we propose the \"The Critical 18\" as a simple yet powerful tool for early risk stratification of pancreatic fistula following distal pancreatectomy. By using WBC > 18 × 10 × 9/L on postoperative day 2 and CRP > 18 mg/dl on postoperative day 3, clinicians can easily identify patients at escalating risk, offering a clear framework for guiding postoperative management and interventions.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13355360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral mucosa necrosis after accidental formaldehyde injection during salivary gland biopsy: case report of a rare preventable complication.","authors":"Othmane Bouanani","doi":"10.1186/s13037-026-00496-w","DOIUrl":"10.1186/s13037-026-00496-w","url":null,"abstract":"<p><strong>Background: </strong>Formaldehyde is a widely used fixative in medical practice. Accidental introduction into the human body can cause rapid protein coagulation, tissue necrosis, and severe systemic complications.</p><p><strong>Case presentation: </strong>We report the case of a 60-year-old woman who received an inadvertent injection of formaldehyde into the inner lower lip during a minor salivary gland biopsy. The patient developed severe pain, labiomental erythema, and mucosal necrosis. She was initially managed with oral antibiotics, but the development of labiomental cellulitis necessitated hospitalization and intravenous antibiotic therapy, followed by surgical necrosectomy and tissue repair. Postoperative care included pro-healing ointment and bicarbonate mouth rinses, leading to complete recovery.</p><p><strong>Conclusion: </strong>This rare case highlights that medical substance handling requires foolproof institutional safeguards. To prevent this severe complication, clinical facilities must ban the reuse of empty medication vials for chemical storage and enforce a strict dual-signature verification protocol prior to any local anesthetic infiltration.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}