Patient Safety in Surgery最新文献

{"title":"Enhancing the quality of surgical care through improved patient handover processes.","authors":"Jessica M Ryan, Deborah A McNamara","doi":"10.1186/s13037-025-00428-0","DOIUrl":"10.1186/s13037-025-00428-0","url":null,"abstract":"<p><p>Surgical handover remains a high-risk process with no gold standard for practice despite 20 years of available guidance. Variability in practice is common, and poorly performed handover poses significant, yet avoidable, risk to patients. Research in this domain is underfunded with widely heterogenous methodology, meaning that the evidence base for better handover is deficient. In this correspondence, recommendations are made to address these shortcomings, including standardised operating procedures supported by electronic health records to enable staff training and audit. Prioritisation of the sickest patients at the handover outset and two-way, verbal communication, including a \"read-back\" to confirm that information is both transmitted and received. Rigorous evaluation of handover interventions before use, and discontinuation of practices that add no value. Lastly, a core outcome set for surgical handover is urgently needed to improve the comparability of studies. By clearly defining best practices and demonstrating the impact of interventions on patient outcomes, surgeons will be more inclined to adopt meaningful improvements in handover processes.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"7"},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634891","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":"Incidence of failure-to-rescue after coronary artery bypass grafting: a multicenter observational study from the REPLICCAR II registry in Brazil.","authors":"Gabrielle Barbosa Borgomoni, Roger Daglius Dias, Pedro Gabriel Melo de Barros E Silva, Marcelo Arruda Nakazone, Marco Antonio Praça de Oliveira, Valquíria Pelisser Campagnucci, Marcos Gradim Tiveron, Luís Augusto Ferreira Lisboa, Ludhmila Abrahão Hajjar, Jorge Passamani Zubelli, Fábio Biscegli Jatene, Omar Asdrúbal Vilca Mejia","doi":"10.1186/s13037-024-00417-9","DOIUrl":"10.1186/s13037-024-00417-9","url":null,"abstract":"<p><strong>Background: </strong>Failure-to-rescue refers to the rate of failure amongst healthcare teams in reversing complications that occur during a patient's hospitalization. This study aimed to investigate the failure-to-rescue rate following coronary artery bypass grafting (CABG).</p><p><strong>Methods: </strong>Cross-sectional cohort study of the multicenter database \"Registro Paulista de Cirurgia Cardiovascular II\" (REPLICCAR II), which includes data from nine reference centers for cardiac surgery in São Paulo State. The study population included patients > 18 years of age who had undergone primary and isolated CABG surgery between 2017 and 2019 in Brazil. The outcome measured was failure-to-rescue (including death and the development of postoperative complications: prolonged ventilation time, stroke, reoperation, and kidney injury). The study used the Society of Thoracic Surgeons (STS) risk score to calculate the expected complication rates.</p><p><strong>Results: </strong>Out of the 3964 patients, 439 developed one or more of the analyzed complications, and out of those, 94 died (2.37% of the full sample). The standardized mortality ratio (SMR) for patients who developed one complication was 8.84% (10.7%/1.21%), whereas those with two combinations of complications had an SMR of 32.34% (53.68%/1.66%) and three complications had an SMR of 42.02% (50%/1.19%). However, patients who progressed without the analyzed complications had an SMR of 0.95% (0.74%/0.80%).</p><p><strong>Conclusion: </strong>The REPLICCAR II database revealed a failure-to-rescue rate of 21.41% (94/439), and the SMR increased progressively according to the greater number of complications. Our findings emphasize the need to measure the impact of early diagnosis and effective hospital team response by parameterizing the risk of expected death after severe complications.</p><p><strong>Trial registration: </strong>The REPLICCAR Registry and The Statewide Quality Improvement Initiative, ID NCT05363696.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"6"},"PeriodicalIF":2.6,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11818038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400287","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":"Medical negligence compensation claims in knee meniscal surgery in Norway: a cross-sectional study.","authors":"Frank-David Øhrn, Asbjørn Årøen, Tommy Frøseth Aae","doi":"10.1186/s13037-025-00427-1","DOIUrl":"10.1186/s13037-025-00427-1","url":null,"abstract":"<p><strong>Background: </strong>Meniscal surgery is one of the most frequent orthopaedic procedures performed worldwide. There is a wide range of possible treatment errors that can occur following meniscal surgery. In Norway, patients subject to treatment errors by hospitals and private institutions can file a compensation claim free of charge to the Norwegian System of Patient Injury Compensation (NPE). The purpose of this study was to systematically analyse compensation claims filed to the NPE following meniscal surgery and evaluate gender effects on accepted claims. Our hypothesis was that there was no gender difference in accepted claims.</p><p><strong>Methods: </strong>We performed a cross-sectional study assessing all registered claims at the NPE after meniscal surgery from 2010 to 2020. The surgical procedures were stratified into subgroups following data collection. Data from the Norwegian Patient Registry were collected to obtain information on the numbers of the different procedures performed in hospitals and private institutions. We calculated frequencies and relative frequencies of categorical data. Differences in categorical data were calculated using the Pearson Chi-square test.</p><p><strong>Results: </strong>The total number of meniscal resections and sutures in the study period was 119,528. A total of 372 compensation claims were filed, 241 male and 130 female. Of these, 152 (40.9%) claims were accepted, while 220 (59.1%) were rejected. The most frequent reasons for filing a compensation claim were pain (114), followed by infection (98), wrong technique (38) and impaired function/instability (25).There was a significant gender difference in the acceptance of claims in favour of men (121 vs. 31, p < 0.001). A sensitivity analysis excluding infection as reason for compensation claim found no gender difference (p = 0.16) in acceptance of claims.</p><p><strong>Conclusion: </strong>Compensation claims after meniscal surgery are rare, with only 0.3% of patients filing a compensation claim. There was a marked preponderance of men with accepted claims due to a higher frequency of postoperative infections. Surgeons should be aware of this and take this into account in the decision-making before surgery.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"5"},"PeriodicalIF":2.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013939","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":"Impact of \"Enhanced Recovery After Surgery\" (ERAS) protocols vs. traditional perioperative care on patient outcomes after colorectal surgery: a systematic review.","authors":"Vaishnavi Kannan, Najeeb Ullah, Sunitha Geddada, Amir Ibrahiam, Zahraa Munaf Shakir Al-Qassab, Osman Ahmed, Iana Malasevskaia","doi":"10.1186/s13037-024-00425-9","DOIUrl":"10.1186/s13037-024-00425-9","url":null,"abstract":"<p><strong>Background: </strong>Colorectal surgery is associated with a high risk of postoperative complications, including technical complications, surgical site infections, and other adverse events affecting patient safety and overall patient experience. \"Enhanced Recovery After Surgery\" (ERAS) is considered a new standard of care for streamlining the perioperative care of surgical patients with the goal of minimizing complications and optimizing timely patient recovery after surgery. This systematic review was designed to investigate the evidence-based literature pertinent to comparing patient outcomes after ERAS versus conventional perioperative care.</p><p><strong>Methods: </strong>This systematic review evaluates the performance of ERAS protocols against conventional care in colorectal surgery, focusing on various postoperative outcome measures. An extensive search was conducted across multiple electronic databases and registers from July 2 to July 5, 2024, complemented by citation searching on November 30, 2024. This approach led to the identification of 11 randomized controlled trials (RCTs) from the past decade, involving 1,476 adult participants. To ensure methodological rigor and transparency, the review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines and was registered with PROSPERO (CRD42024583074).</p><p><strong>Results: </strong>The implementation of ERAS protocols resulted in a notable decrease in hospital stay duration compared to conventional care, with reductions varying between 3 and 8 days across studies. ERAS patients also had faster gastrointestinal recovery, including quicker times to bowel movement, defecation, and resumption of normal diet. Furthermore, patients in ERAS groups showed notably reduced postoperative complications and opioid consumption, with patients experiencing lower pain scores on the Visual Analogue Scale (VAS) and reduced reliance on opioids. Additionally, nutritional recovery in ERAS patients was enhanced, with elevated albumin and total protein levels, alongside decreased inflammatory markers and improved immune function.</p><p><strong>Conclusion: </strong>This systematic review provides compelling evidence supporting the integration of ERAS protocols into standard colorectal surgical practices. Future studies should aim to explore the variations in ERAS implementation, pinpoint the most impactful elements of ERAS, and work towards personalizing and standardizing these protocols across clinical settings. Additionally, evaluating long-term outcomes will help refine ERAS strategies, ensuring their enduring impact on patient recovery.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"4"},"PeriodicalIF":2.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11737126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013935","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":"Exploring strategies to enhance patient safety in spine surgery: a review.","authors":"Kimia Baradaran, Constana Gracia, Ehsan Alimohammadi","doi":"10.1186/s13037-025-00426-2","DOIUrl":"10.1186/s13037-025-00426-2","url":null,"abstract":"<p><p>Patient safety is the foundation of spine surgery, where the intricate nature of spinal procedures and the unique risks involved call for exceptional diligence and comprehensive protocols. In this high-stakes field, developing and implementing rigorous safety protocols is not only vital for minimizing complications but also for achieving the best possible outcomes and strengthening the confidence patients have in their care team. Each patient entrusts their well-being to their surgical team. This trust underscores the responsibility healthcare providers have to prioritize safety at every stage. In spine surgery, thorough preoperative planning, clear communication during informed consent, and vigilant postoperative care are all crucial for creating a safe environment tailored to each patient's needs. A commitment to patient safety requires more than individual efforts; it calls for a coordinated, multidisciplinary approach where surgeons, nurses, anesthesiologists, and rehabilitation specialists work closely together. This collaboration ensures that each step of the patient's journey is aligned with best practices for safety and care. This review highlights the critical need for ongoing evaluation and refinement of safety protocols in spine surgery. As surgical techniques and technologies advance, and as patients' needs evolve, healthcare teams must remain responsive, cultivating a culture of safety that is both proactive and adaptable. Continuous investment in quality improvement and research is essential to fine-tune these protocols, ensuring they remain both relevant and effective in addressing the unique challenges of spine surgery. Prioritizing comprehensive safety measures goes beyond improving surgical outcomes; it plays a pivotal role in strengthening the trust and confidence patients have in their healthcare providers. By committing to these robust protocols, we reaffirm our dedication to patient-centered care, enhancing not only patient safety and recovery but also fostering a deeper faith in a healthcare system that places patient well-being at the forefront.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"3"},"PeriodicalIF":2.6,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985178","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":"Does the AO/OTA fracture classification dictate the anesthesia modality for the surgical management of unstable distal radius fractures? - A retrospective cohort study in 127 patients managed by general vs. regional anesthesia.","authors":"Sascha Halvachizadeh, Merav Dreifuss, Thomas Rauer, Anne Kaiser, Dirk Ubmann, Hans-Christoph Pape, Florin Allemann","doi":"10.1186/s13037-024-00423-x","DOIUrl":"10.1186/s13037-024-00423-x","url":null,"abstract":"<p><strong>Introduction: </strong>Regional anesthesia increases in popularity in orthopaedic surgery. It is usually applied in elective surgeries of the extremities. The aim of this study was to assess indication of the use of general anesthesia in the surgical treatment of distal radius fractures.</p><p><strong>Methods: </strong>Patients undergoing surgical fixation for distal radius fractures between January 1st, 2020, and December 31st, 2021, were included. Exclusion criteria encompassed incomplete 12-month follow-up, transferred or multiply injured patients, those with prior upper limb fractures, or admission for revision surgeries. Patients were categorized by anesthesia type: GA or plexus block anesthesia (PA). Primary outcomes comprised tourniquet utilization and duration of surgery, while secondary outcomes encompassed complications (e.g., complex regional pain syndrome [CRPS], local wound infection, implant removal necessity) and range of motion at three, six, and twelve months post-surgery. Fractures were classified using the AO/OTA system.</p><p><strong>Results: </strong>The study enrolled 127 patients, with 90 (70.9%) in Group GA and 37 (29.1%) in Group PA. Mean patient age was 56.95 (± 18.59) years, with comparable demographics and fracture distribution between groups. Group GA exhibited higher tourniquet usage (96.7% vs. 83.8%, p = 0.029) and longer surgery durations (85.17 ± 37.8 min vs. 65.0 ± 23.0 min, p = 0.013). Complication rates were comparable, Group GA 12.2% versus Group PA 5.4% p = 0.407, OR 2.44; 95%CI 0.51 to 11.58, p = 0.343). Short-term functional outcomes favored Group PA at three months (e.g., Pronation: 81.1° ± 13.6 vs. 74.3° ± 17.5, p = 0.046).</p><p><strong>Conclusion: </strong>Solely classifying distal radius fractures does not dictate anesthesia choice. Complexity of injury, anticipated surgery duration, less use of tourniquet, and rehabilitation duration may guide regional anesthesia utilization over GA in distal radius fracture fixation.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"2"},"PeriodicalIF":2.6,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11716251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956824","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":"Predicting loss of independence among geriatric patients following gastrointestinal surgery.","authors":"Michaela R Cunningham, Christopher L Cramer, Ruyun Jin, Florence E Turrentine, Victor M Zaydfudim","doi":"10.1186/s13037-024-00424-w","DOIUrl":"10.1186/s13037-024-00424-w","url":null,"abstract":"<p><strong>Background: </strong>While existing risk calculators focus on mortality and complications, elderly patients are concerned with how operations will affect their quality of life, especially their independence. We sought to develop a novel clinically relevant and easy-to-use score to predict elderly patients' loss of independence after gastrointestinal surgery.</p><p><strong>Methods: </strong>This retrospective cohort study included patients age ≥ 65 years enrolled in the American College of Surgeons National Surgical Quality Improvement Program database and Geriatric Pilot Project who underwent pancreatic, colorectal, or hepatic surgery (January 1, 2014- December 31, 2018). Primary outcome was loss of independence - discharge to facility other than home and decline in functional status. Patients from 2014 to 2017 comprised the training data set. A logistic regression (LR) model was generated using variables with p < 0.2 from the univariable analysis. The six factors most predictive of the outcome composed the short LR model and scoring system. The scoring system was validated with data from 2018.</p><p><strong>Results: </strong>Of 6,510 operations, 841 patients (13%) lost independence. Training and validation datasets had 5,232 (80%) and 1,278 (20%) patients, respectively. The six most impactful factors in predicting loss of independence were age, preoperative mobility aid use, American Society of Anesthesiologists classification, preoperative albumin, non-elective surgery, and race (all OR > 1.83; p < 0.001). The odds ratio of each of these factors were used to create a sixteen-point scoring system. The scoring system demonstrated satisfactory discrimination and calibration across the training and validation datasets, with Receiver Operating Characteristic Area Under the Curve 0.78 in both and Hosmer-Lemeshow statistic of 0.16 and 0.34, respectively.</p><p><strong>Conclusions: </strong>This novel scoring system predicts loss of independence for geriatric patients after gastrointestinal operations. Using readily available variables, this tool can be applied in the urgent setting and can contribute to elderly patients and their family discussions related to loss of independence prior to high-risk gastrointestinal operations. The applicability of this scoring tool to additional surgical sub-specialties and external validation should be explored in future studies.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11715953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956850","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":"Evolution of management strategies for unstable pelvic ring injuries over the past 40 years: a systematic review.","authors":"Kenichi Sawauchi, Luca Esposito, Yannik Kalbas, Zygimantas Alasauskas, Valentin Neuhaus, Hans-Christoph Pape, Felix Karl-Ludwig Klingebiel, Roman Pfeifer","doi":"10.1186/s13037-024-00421-z","DOIUrl":"10.1186/s13037-024-00421-z","url":null,"abstract":"<p><strong>Background: </strong>Hemodynamically unstable pelvic ring fractures from high-energy trauma are critical injuries in trauma care, requiring urgent intervention and precise diagnostics. With ongoing advancements in trauma management, treatment strategies have evolved, with some techniques becoming obsolete as new ones emerge. This study aimed to evaluate changes and trends in treatment algorithms for these injuries over approximately 40 years.</p><p><strong>Methods: </strong>A systematic review of PubMed and EMBASE was conducted to include articles published over roughly four decades that presented visual treatment algorithms or workflows for managing unstable pelvic ring fractures. Identified algorithms were categorized by publication period and analyzed by initial assessment, diagnostic methods, pelvic stabilization, and hemorrhage control interventions.</p><p><strong>Results: </strong>The search identified 5,434 publications, of which 32 met the inclusion criteria. 75% of these studies were published between 2011 and 2022, reflecting a growing focus on standardization, particularly in Europe, North America, and Asia. Physiological assessment remains essential in the initial management of hemodynamically unstable pelvic ring fractures, guiding resuscitation and influencing the selection of intervention and imaging. The use of pelvic binders or sheets has risen steadily, highlighting their role in hemorrhage control and temporary stabilization. CT scans and angiography have largely replaced pelvic X-rays in diagnostic protocols, becoming preferred radiological methods alongside focused assessment with sonography for trauma (FAST). Pelvic stabilization remains critical, with external fixation being the most commonly used technique, showing an upward trend in recent years. Laparotomy, pelvic packing, and angioembolization continue to play vital roles in hemorrhage management. Emerging techniques, such as resuscitative endovascular balloon occlusion of the aorta (REBOA), anterior subcutaneous internal fixation (INFIX), and rescue screws, are increasingly included in treatment algorithms, while diagnostic peritoneal lavage (DPL) has become obsolete and is no longer listed in these algorithms.</p><p><strong>Conclusions: </strong>This review provides foundational insights toward the standardization of initial treatment for hemodynamically unstable pelvic ring fractures and holds significant importance in enhancing the consistency and efficiency of treatment. Future research should focus on accumulating higher-quality evidence to evaluate the effectiveness of standardized protocols and explore the applicability of new treatment methods.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"18 1","pages":"38"},"PeriodicalIF":2.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11673330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899149","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":"Machine learning approaches for improvement of patient safety in surgery.","authors":"Philip F Stahel, Kathryn Holland, Roy Nanz","doi":"10.1186/s13037-024-00422-y","DOIUrl":"10.1186/s13037-024-00422-y","url":null,"abstract":"","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"18 1","pages":"37"},"PeriodicalIF":2.6,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11662825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873252","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":"A novel minimally invasive neurosurgical cranial fixation device for improved accuracy of intraventricular catheter placement: an experimental animal study.","authors":"Atai Daniel, Matan Coronel, Segev Peer, Ben Grinshpan, Soner Duru, Jose L Peiro, James L Leach, Elena Abellán, Carolyn M Doerning, David Zarrouk, Francesco T Mangano","doi":"10.1186/s13037-024-00420-0","DOIUrl":"10.1186/s13037-024-00420-0","url":null,"abstract":"<p><strong>Background: </strong>External ventricular drain (EVD) insertion is one of the most commonly performed neurosurgical procedures. Herein, we introduce a new concept of a cranial fixation device for insertion of EVDs, that reduces reliance on freehand placement and drilling techniques and provides a simple, minimally invasive approach that provides strong fixation to minimal thickness skulls.</p><p><strong>Methods: </strong>An experimental device for catheter insertion and fixation was designed and tested in both ex-vivo and in-vivo conditions to assess accurate cannulation of the ventricle and to test the strength of fixation to the skull. The ex-vivo experiments were conducted at Ben-Gurion University of the Negev (BGU) in Be'er Sheva, Israel. These experiments included functionality bench testing and pullout force measurements for the ball mechanism and catheter fixation. For the in-vivo experiments the fixation device was initially tested at the Cincinnati Children's Hospital Medical Center (CCHMC) in Cincinnati, Ohio on one day of life 1 (DOL 1) male control lamb. Additional experiments were conducted on 3 hydrocephalic DOL 0 lambs (1 male 2 female) at the Jesús Usón Minimally Invasive Surgery Centre (JUMISC) in Caceres, Spain. The hydrocephalic animal model used for this study was created with in utero intracisternal injection of BioGlue in fetal lambs. The catheter insertion trajectory was determined using MR imaging to assess the device's impact on the placement accuracy. The fixation device was evaluated on reaching the ventricle and enabling extraction of CSF for all 7 fixations placed. For 5 of the fixation devices, post-mortem pullout force was measured. The general functionality of the device was also evaluated.</p><p><strong>Results: </strong>In the experiments, 7/7 (100%) catheter trajectories successfully reached the ventricle without any apparent complications related to the device or the procedure. The cranial fixation device base demonstrated significant strength in withstanding an average pull-out force of 4.18kgf (STD[Formula: see text]0.72, N = 5) without detachment from the subject's skull for all 5 devices included in this test. Additionally, the EVD catheter pull test was conducted with the addition of a safety loop which did not allow movement of the EVD to a force of 3.6kgf. At this force the catheter tore but did not release from its fixation point.</p><p><strong>Conclusion: </strong>The newly designed experimental device demonstrates initial proof of concept from ex vivo and in vivo testing. It appears suitable for accurate ventricular catheter placement and cranial fixation.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"18 1","pages":"36"},"PeriodicalIF":2.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11657085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855885","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}