Patient Safety in Surgery最新文献

{"title":"Incidence and predictors of failed spinal anesthesia: a systematic review and meta-analysis.","authors":"Sitotaw Tesfa Zegeye, Belete Muluadam Admassie, Esubalew Muluneh Aligaz, Fikadu Tadese Dires, Samuel Debas Bayable","doi":"10.1186/s13037-025-00457-9","DOIUrl":"10.1186/s13037-025-00457-9","url":null,"abstract":"<p><strong>Background: </strong>Spinal anesthesia is a widely used and effective regional technique, yet its failure can occur, potentially leading to patient discomfort and requiring alternative methods. Therefore, this systematic review and meta-analysis aimed to assess the pooled incidence of spinal anesthesia failure and identify associated factors.</p><p><strong>Methods: </strong>This systematic review was prospectively registered in PROSPERO (CRD420251101582). A comprehensive literature search was conducted across PubMed, Embase, the Cochrane Library, Web of Science, and Google Scholar for studies published between January 2015 and May 2025. Using a random-effects model, we calculated the pooled incidence of failed spinal anesthesia and the pooled odds ratios (ORs) for potential predictors. Heterogeneity among studies was assessed using the I² statistic.</p><p><strong>Results: </strong>Twenty-one studies involving 44,790 participants were analyzed. The pooled incidence of failed spinal anesthesia was found to be 8.36% (95% CI: 6.94-9.78). Significant predictors included bar city and dose of local anesthetics, provider inexperience, bloody cerebrospinal fluid, emergency surgery, history of anesthesia, body mass index, lumbar puncture performed at the L4-L5 interspaces, and absence of free CSF flow.</p><p><strong>Conclusion: </strong>The failure rate of spinal anesthesia is significant. Our findings highlight the importance of standardized techniques, optimization of local anesthetic dosage, and continuous training to reduce failures, particularly in resource-limited settings. Key associated factors considered to reduce failures.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":" ","pages":"1"},"PeriodicalIF":2.1,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12797430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640210","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":"Artificial intelligence and machine learning approaches for patient safety in complex surgery: a review.","authors":"Mohamed Mustaf Ahmed, Zhinya Kawa Othman, Uthman Okikiola Adebayo, Omar Kasimieh, Olalekan John Okesanya, Shuaibu Saidu Musa, Francesco Branda, Victor C Cañezo, Edgar G Cue, Don Eliseo Lucero Prisno Iii","doi":"10.1186/s13037-025-00458-8","DOIUrl":"10.1186/s13037-025-00458-8","url":null,"abstract":"","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"33"},"PeriodicalIF":2.1,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12648791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145606849","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 surgeon experience on patient outcomes after pelvic and acetabular fracture surgery.","authors":"Mark Ayoub, Yeng Vue, Emilio Robles, Jetha Tallapaneni, Armen Martirosian","doi":"10.1186/s13037-025-00455-x","DOIUrl":"10.1186/s13037-025-00455-x","url":null,"abstract":"","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"32"},"PeriodicalIF":2.1,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12628896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551268","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":"Smart technologies and digital innovations for improving perioperative patient safety: a review.","authors":"Saeid Amini Rarani","doi":"10.1186/s13037-025-00454-y","DOIUrl":"10.1186/s13037-025-00454-y","url":null,"abstract":"<p><p>Smart digital technologies are rapidly transforming perioperative care through tools such as clinical decision support systems, wearable sensors, and electronic checklists. Despite growing adoption, their specific impact on patient safety in the operating room remains insufficiently understood. This narrative review explores recent advancements in perioperative digital health and examines how innovations like AI-assisted systems, electronic WHO checklists, and physiological monitoring wearables contribute to safer surgical care. The evidence suggests that these tools can enhance complication detection, protocol adherence, and team communication. However, their effectiveness is tempered by challenges including alert fatigue, fragmented data systems, and added digital workload for healthcare staff. To realize their full potential, future implementations must prioritize usability, interoperability, and seamless workflow integration. Rigorous clinical trials and cost-effectiveness studies are also needed to establish the true value of smart technologies in improving surgical patient outcomes.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"31"},"PeriodicalIF":2.1,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12573887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145402515","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":"Chronically retained gauze (gossypiboma) resembling a mature cystic teratoma after Cesarean delivery: a case report.","authors":"Temesgen Tilahun","doi":"10.1186/s13037-025-00452-0","DOIUrl":"10.1186/s13037-025-00452-0","url":null,"abstract":"<p><strong>Background: </strong>A foreign body left behind during an operation is a medico-legal issue. It is an infrequent but avoidable surgical complication, which must be kept in mind in any postoperative patient who presents with pain, infection, or palpable mass. The author presents a rare case of chronic gossypiboma following a Cesarean delivery in a 40-year-old woman, who was a Para III patient from Western Ethiopia. She had been experiencing dull, aching pain since her previous Cesarean section four years prior. To address her complaints, she visited multiple health facilities where she was prescribed pain relief medications and antibiotics. The patient was eventually taken to the operating room with a preliminary diagnosis of a mature cystic teratoma. However, during laparotomy, surgical gauze was discovered and successfully removed.</p><p><strong>Conclusion: </strong>In patients who have previously undergone surgery for obstetric or other gynecological procedures and present with vague abdominal complaints, it is important to consider the possibility of a chronic gossypiboma mimicking a mass of unknown origin. Following established surgical protocols and implementing new preventive measures, such as using tagged gauze/ radio-opaque markers, and ongoing staff training could help reduce or prevent the occurrence gossypiboma. Additionally, the author advises performing delicate surgical procedures to remove retained gauze to prevent bleeding and tissue damage. The gauze should be gently lifted, and the wound must be examined for any damage.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"29"},"PeriodicalIF":2.1,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12560319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145379351","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":"Hypoxia-Inducible Factor 1-alpha (HIF1α), Nicotinamide Adenine Dinucleotide (NAD+, NADH), and Nitric Oxide (NO) interplay in critically ill patients, with implications for patient safety and targeted therapies: a review.","authors":"David Bar-Or, Kaysie Banton, David Acuna, Jason Williams, Carlos H Palacio, Charles W Mains, Raymond Garrett","doi":"10.1186/s13037-025-00453-z","DOIUrl":"10.1186/s13037-025-00453-z","url":null,"abstract":"","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"30"},"PeriodicalIF":2.1,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12560285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145379354","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":"High prevalence of unrecognized postoperative delirium in elderly patients: a prospective cohort study from a resource-limited country.","authors":"Arinze Duke George Nwosu, Edmund Ndudi Ossai, Cyprian Chukwuebuka Nganwuchu, Francis Ndubuisi Ahaotu, Ndubuisi Ebere Duru","doi":"10.1186/s13037-025-00439-x","DOIUrl":"10.1186/s13037-025-00439-x","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium is a frequent complication following surgery in elderly patients. Despite its strong association with poor health outcomes the literature in Nigeria has been limited to a few case-reports. A major barrier to improving delirium care in elderly individuals is its poor detection, particularly in surgical populations. We aimed to determine the incidence, detection rate and risk factors for postoperative delirium in our cohort of elderly surgical patients.</p><p><strong>Methods: </strong>We conducted a prospective cohort study in a regional orthopedic and plastic surgical center in Enugu, Southeast Nigeria, between April 2020 and March 2024. The participants were patients aged 65 years and above, who underwent surgical procedures. Each patient was visited daily by a trained nonpsychiatrist physician during the first three days after surgery and was assessed for delirium during each visit. The \"Confusion Assessment Method\" algorithm was used for the diagnosis of delirium. The motor subtypes were classified on the basis of the predominant psychomotor disturbance (hyperactive, hypoactive, mixed, or none). Multivariate analysis via binary logistic regression was used to determine the predictors of delirium. The level of statistical significance was determined by a p value of < 0.05.</p><p><strong>Results: </strong>Data from 304 patients (mean age, 71.7 ± 6.4 years) were analyzed. The incidence of postoperative delirium was 24.0% (73/304). The delirium subtype manifestations were \"hypoactive\" 35.6%, \"hyperactive\" 35.6%, \"mixed\" 20.5%, and \"none\" 8.2%. Approximately 92% (67/73) of the delirious cases presented within 48 h following surgery. Among the delirious cases, 90.4% (66/73) were undetected by the managing surgical teams and nursing personnel. The predictors of delirium were perioperative anaemia (AOR = 4.6; 95% CI: 1.3-16.5), impaired preoperative cognitive status; (AOR = 4.5; 95% CI: 2.0-9.9), perioperative blood transfusion (AOR = 2.1; 95% CI: 1.1-4.2), and surgery lasting between 120 and 179 min (AOR = 0.3; 95% CI: 0.1-0.8).</p><p><strong>Conclusion: </strong>Postoperative delirium was grossly underrecognized by the managing surgical teams and nursing personnel. Education of the healthcare providers, with implementation of routine monitoring for postoperative delirium using validated tools is recommended. Perioperative anaemia and blood transfusion were modifiable risk factors for postoperative delirium in these patients, and improvements in patient blood management offer great potential for safer care.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"28"},"PeriodicalIF":2.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12535065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313705","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":"Surgeons' physiological parameters and surgical performance: a systematic scoping review.","authors":"Léa Pascal, Simon Ducarroz, Sarah C Skinner, Quentin Cordier, Jean-Christophe Lifante, Stéphanie Mazza, Antoine Duclos","doi":"10.1186/s13037-025-00445-z","DOIUrl":"10.1186/s13037-025-00445-z","url":null,"abstract":"","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"27"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207923","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":"Anatomic reference measures for central airway anatomy in Indian adults: implications for precision airway management in surgical patient safety.","authors":"Purnima Adhikari, Chandni Gupta, Koteshwara Prakashini, Rahul Magazine, Mohan K Manu, Santa Kumar Das, Sharma Paudel","doi":"10.1186/s13037-025-00450-2","DOIUrl":"10.1186/s13037-025-00450-2","url":null,"abstract":"<p><strong>Background: </strong>Despite the critical role of central airway dimensions in clinical practice, comprehensive normative data remain scarce globally, particularly for diverse ethnic populations. This study aims to establish the first high-resolution computed tomography (HRCT) based reference values for tracheobronchial anatomy in Indian adults, addressing a significant gap in precision medicine.</p><p><strong>Methods: </strong>This retrospective cross-sectional study was conducted at Kasturba Hospital, Manipal, India. HRCT chest scans performed between January 1, 2021, and March 31, 2024, were screened, and 503 adults (277 males, 226 females; aged 20-80 years) with normal findings were included. Primary outcomes were normative tracheal and bronchial dimensions (lengths, diameters, cross-sectional areas). Secondary outcomes included age and gender-based variations, correlations with demographics, and predictive models for airway device selection. Inclusion criteria were HRCT scans with normal thoracic findings and adequate inspiratory effort. Exclusion criteria included thoracic, pulmonary or cardiac abnormalities, prior airway surgery, presence of airway devices, or severe imaging artifacts. Data were analysed using t-test, one-way ANOVA, Pearson correlations, and multiple linear regression. Statistical significance was set at p < 0.05.</p><p><strong>Results: </strong>Indian males exhibited significantly larger airways than females (tracheal length: 109.5 ± 8.9 mm vs. 100.5 ± 7.4 mm, p < 0.001; distal tracheal area: 311.3 ± 111.1 mm² vs. 227.6 ± 92.9 mm², p < 0.001). Notably, 54.5% of subjects had a more vertical left bronchus, contradicting classical anatomical dogma. High rates of short right main bronchi (< 23 mm) were observed in 49.5% of subjects, increasing the risk of double-lumen endobronchial tube misplacement. The distal tracheal diameter was strongly correlated with bronchial dimensions (r = 0.621, p < 0.001), providing evidence-based device selection.</p><p><strong>Conclusion: </strong>This study provides the first population-specific normative data for central airway dimensions in Indian adults, revealing profound ethnic variations with immediate clinical implications for airway management, thoracic surgery, and personalised medical device design. The findings underscore the necessity of region-specific reference standards to optimise patient safety and highlight the influence of ethnicity on airway anatomy.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"26"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207925","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":"Classification-based treatment of periprosthetic fractures around total elbow arthroplasty: a systematic review and meta-analysis.","authors":"Lara Zankena, Lisa Luna Beck, Christian Hierholzer, Hans-Christoph Pape, Sascha Halvachizadeh, Florin Allemann","doi":"10.1186/s13037-025-00447-x","DOIUrl":"10.1186/s13037-025-00447-x","url":null,"abstract":"<p><strong>Introduction: </strong>Treatment of periprosthetic fractures around the elbow remains a challenge. The goal of this study was to present classification-based treatment strategies of periprosthetic fractures around elbow prosthesis.</p><p><strong>Methods: </strong>This study was designed as a systematic review and meta-analysis of published articles in English or German language that investigated classification systems and treatment strategies of fractures around elbow prosthesis without timeframe limitations. Articles without full-text availability were excluded. The search included the following data bases: Medline, EMBASE, Cochrane and Web of Science (WoS). The fractures where classified according to the most commonly utilized classification system. Outcome parameters included follow-up time, bone union and range of motion. After deduplication title and abstract screening and full-text analyses were performed by two independent researchers. Risk of bias assessment was performed with the Revised Cochrane risk of bias tool (ROBINS 1) for non-randomized studies.</p><p><strong>Results: </strong>This systematic review included 26 articles that included 11 reviews (42.3%), 12 case reports (46.1%) and 3 (11.6%) cohort studies. In total 85 patients were included with a mean age of 68.7 (SD 11.1) years. Most patients were female (n = 61, 73.5%). Fractures were all classified according to Mayo classification. In most reports, type 1 fractures without stem loosening were treated non-operatively, type 2 and 3 fractures without stem loosening with fracture fixation, type 2 fractures with stem loosening with revision arthroplasty. The time to bone union was comparable in fracture fixation versus revision surgery (18.2, SD 9.4 weeks vs. 12.3, SD 5.4 weeks, p = 0.294). The degree/ (or range) of extension was comparable in both groups (9.8, SD 11.2° versus 17.4, SD 16.6°, p = 0.335). The degree of flexion was comparable in both groups (117.5, SD 15.1° versus 127.9, SD 10.3°, p = 0.335).</p><p><strong>Conclusion: </strong>Treatment of periprosthetic fractures around elbow arthroplasty remains a challenge. The treatment strategy is based on the location of the fracture and the stability of the elbow prosthesis. The lack of high-quality research prohibits a final evidence- based recommendation for the treatment of periprosthetic fractures around the elbow.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"25"},"PeriodicalIF":2.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201397","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}