Patient Safety in Surgery最新文献

{"title":"Overuse in surgery by deviation from the \"Choosing Wisely\" campaign recommendations: a surrogate of unnecessary surgery and low-value care.","authors":"Ana Garcia-Santa-Vinuela, Jorge Vicente-Guijarro, Diego San Jose-Saras, Paulo Sousa, Cristina Díaz-Agero Pérez, Jesús María Aranaz-Andres","doi":"10.1186/s13037-026-00477-z","DOIUrl":"10.1186/s13037-026-00477-z","url":null,"abstract":"<p><strong>Background: </strong>Inappropriate health care reduces the quality of care and efficiency of the health system. The goal of this study was to analyze the frequency of overuse of five surgical procedures while also determining the epidemiological characteristics of both patients and interventions.</p><p><strong>Methods: </strong>This is a retrospective observational cohort study performed in a tertiary referral center in Spain. Surgical Overuse was analyzed according to five \"Choosing Wisely\" recommendations related to both interventions and perioperative care. The association between overuse and the characteristics of patients and procedures was assessed by bivariate and multivariate predictive analysis. Costs were calculated for each clinical episode using data from the hospital's accounting department; total hospitalization costs from the index procedure to hospital discharge were used for intervention-related overuse, and average unit cost for perioperative practices.</p><p><strong>Results: </strong>A total of 895 clinical episodes were analyzed over one year. Low-value surgery was identified in 9.7% (N: 87; 95% CI: 7.9 to 11.9). Specifically, overuse was identified in 59.6% (53 out of 89; 48.6 to 69.7)) of the echocardiograms performed after valve replacement, 15.7% (26 out of 166; 10.6 to 22.3) of podiatric surgeries, and 2.0% (8 out of 400; 0.9 to 4.1) of cholecystectomies for asymptomatic cholelithiasis. No overuse was found among Mohs surgeries or in the perioperative use of opioids for pediatric patients. The risk of overuse was higher in patients with the following characteristics: increased age (OR [95% CI]: 1.1 [1.1 to 1.2] for each additional year); ≥1 intrinsic risk factor (IRF) (3.5 [1.5 to 8.0] versus absence of IRF); and hospitalized patients (12.8 [4.5 to 37.1] versus ambulatory surgery). Overuse represented an overall cost of €86,858.05.</p><p><strong>Conclusion: </strong>Applying five \"Choosing Wisely\" recommendations, low-value surgical practices were identified, mainly involving echocardiograms after valve replacement, podiatric surgery, and cholecystectomies. Such practices were more frequent among older and hospitalized patients and were associated with direct economic costs.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13015106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208059","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":"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/s13037-025-00467-7","DOIUrl":"10.1186/s13037-025-00467-7","url":null,"abstract":"<p><p>BACKGROUND: Audiovisual recording technology, referred to as the Operating Room Black Box (ORBB), is increasingly adopted in operating rooms (ORs) across several countries. It is described as beneficial, with potential to improve training, performance, and patient safety. However, its implementation raises ethical and legal concerns, such as privacy, data security, and fears of misuse. These challenges require careful consideration alongside anticipated benefits. In France, ORBB use is emerging, yet no data exist on perceptions of professionals and patients. This study aims to identify obstacles and facilitators to ORBB implementation in French ORs. METHODS: An observational, prospective, multicenter study was conducted, with questionnaire responses collected overall between 13 April 2023 and 16 July 2024. Three digital questionnaires were used: a 14-item questionnaire for anesthesia professionals, a 16-item questionnaire for surgical professionals, and a 16-item questionnaire for patients. These were distributed via partner organizations, including professional societies and patient associations. Data included sociodemographic information and opinions on risks, benefits, and conditions of ORBB implementation. RESULTS: The study included responses from 831 participants: 45.5% anesthesia professionals, 38.6% surgical professionals, and 15.9% patients. While many professionals (80.7%) recognized educational benefits, concerns about privacy (77.8%) and anxiety from constant monitoring (80.1%) were prominent. Patient perspectives were generally supportive, with 84.8% in favor, and many viewed ORBB as enhancing accountability (77.3%). Nevertheless, privacy concerns remained (66.7%). CONCLUSION: These results, from the first national survey of its kind in France, provide insights into stakeholder expectations and concerns. Patient and professional perspectives show both overlaps and divergences, which must be considered to guide ORBB deployment. </p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"20 1","pages":"7"},"PeriodicalIF":3.3,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12870878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146114535","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":"Beyond incidence: clarifying the evidence-based predictors of failed spinal anesthesia.","authors":"Tuhin Mistry, Abhijit Sukumaran Nair","doi":"10.1186/s13037-025-00471-x","DOIUrl":"10.1186/s13037-025-00471-x","url":null,"abstract":"","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"20 1","pages":"4"},"PeriodicalIF":2.1,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12857137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087581","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":"Patient safety culture in the operating room of African hospitals: a systematic review.","authors":"Jacques Fadhili Bake, Naicen Ghanmi, Elena Guadagno, Kasereka Masumbuko Claude, Tsongo Kibendelwa Zacharie, Dan Poenaru","doi":"10.1186/s13037-025-00461-z","DOIUrl":"10.1186/s13037-025-00461-z","url":null,"abstract":"<p><strong>Background: </strong>Patient safety in operating rooms has globally improved through interventions such as the World Health Organization (WHO) Surgical Safety Checklist and multidisciplinary team training. However, while evidence from high-income countries is well documented, there remains limited consolidated knowledge on the understanding, application, and effectiveness of safety culture interventions in African surgical settings, which this review seeks to address.</p><p><strong>Methods: </strong>This systematic review examined factors and protocols affecting surgical safety in African operating rooms. We hypothesized that persistent systemic barriers undermine safety culture despite adoption of global measures. Following PRISMA 2020, we searched eight databases (Medline, Embase, Cochrane, Africa-Wide, CINAHL, Global Health, Global Index Medicus, Web of Science) from inception to 5 December 2024, using variations of text words present in the title, abstract, or keyword fields, alongside relevant subject headings, to identify articles addressing surgical safety and culture throughout Africa. Included studies involved operating room professionals in African countries and used quantitative, qualitative, or mixed-methods designs. We excluded non-operating room settings, patient-only studies, inaccessible full texts, reviews, editorials, letters, conference abstracts, and duplicates. Two reviewers independently screened and appraised studies using the Mixed Methods Appraisal Tool. Findings were synthesized narratively with subgroup analysis by study type and theme.</p><p><strong>Results: </strong>Out of 9,875 identified records, 22 studies from 12 African countries (2014-2024) met inclusion criteria, with Ethiopia contributing the highest number (n = 4). Various assessment tools, including the Hospital Survey on Patient Safety Culture, the Safety Attitudes Questionnaire, and the National Surgical, Obstetric, and Anaesthesia Plans interview manual, revealed recurring challenges: inadequate non-punitive responses to errors, communication barriers, hierarchical structures, and resource constraints. Four interventions showed promise: implementation and training on the WHO Surgical Safety Checklist, Safe Surgery 2020 initiatives, Non-Technical Skills for Surgeons training, and multidisciplinary training.</p><p><strong>Conclusion: </strong>The heterogeneity of study designs, sample sizes, and outcome measures limited direct comparisons and precluded meta-analysis. Nonetheless, the review highlights persistent barriers and emerging opportunities to strengthen patient safety culture in African operating rooms. While the WHO Surgical Safety Checklist remains valuable, sustainable progress requires multi-level strategies that address systemic constraints and incorporate context-sensitive adaptations.</p><p><strong>Registration: </strong>PROSPERO, CRD42024627076.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"20 1","pages":"5"},"PeriodicalIF":2.1,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12857098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087489","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' personal cloth scrub caps: harmless perk or implicit infection prevention risk?","authors":"Jenna Hughes, Emily M Pilc, Clifton Bridges, Hans Robert Tuten","doi":"10.1186/s13037-025-00465-9","DOIUrl":"10.1186/s13037-025-00465-9","url":null,"abstract":"<p><p>BACKGROUND: Many hospitals are implementing requirements for disposable-only scrub caps in the operating room as an infection prevention measure. Current literature has not identified a significant difference in the infection risk between cloth and disposable scrub caps. This study seeks to address this issue at the cap level by determining the difference in bacterial colonization between cloth and paper scrub caps. With consideration for potential contamination associated with environments beyond the operating room, it was predicted that personal cloth scrub caps would have a higher infectious load than disposable caps. METHODS: This study was designed as a prospective cohort study at a non-profit, 391 bed medical center in the United States. The sample included scrub caps from 107 medical personnel within the sterile field, including surgeons, physician assistants, nurse practitioners, surgical assistants, and scrub nurses. Medical personnel wore the cap style and material of their choice. The swab collections were cultured for 3 days on blood agar plates and were evaluated for bacterial colony growth and were quantified on the following scale: 0 – no bacterial growth, 1 – few colonies, 2 – several colonies, but less than 50% coverage, 3 – significant colonization at over 50% coverage, and 4 – full or nearly full colonization. The data was then calculated for statistical significance. RESULTS: A total of 107 samples were obtained, including 58 from cloth scrub caps and 49 from paper scrub caps. On disposable paper caps, the mean number of colony forming units was 1.06 (SD = 3.60), and the mean growth rank was 0.20 (SD = 0.61). On reusable cloth caps, the mean number of colony forming units was 5.16 (SD = 11.78), and the mean growth rank was 0.93 (SD = 0.99). Using a Mann-Whitney U test to evaluate the effect of cap type on colony forming units and growth rank, reusable cloth caps were found to be associated with increased colony forming units (p < 0.001) and increased growth rank (p < 0.001). CONCLUSION: Reusable cloth scrub caps were found to have more colony forming units and higher growth ranks than disposable paper scrub caps. Attention should be given to the proper sterilization of cloth scrub caps in order to decrease the infectious load on items in the operating room. </p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"20 1","pages":"2"},"PeriodicalIF":3.3,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12857111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087507","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":"Labeled surgical caps improve perioperative patient safety and interprofessional communication in the operating room: a scoping review.","authors":"Loraine P Kouba, Adriano Fabi, Sebastian Bayer, Christian Abshagen, Melanie A Kalweit-Dietsche, Sarah Tschudin-Sutter, Kathrin Bourdeu, Thierry Girard, Elisabeth A Kappos","doi":"10.1186/s13037-025-00473-9","DOIUrl":"10.1186/s13037-025-00473-9","url":null,"abstract":"<p><p>BACKGROUND: Effective communication is critical for patient safety and surgical outcomes inside the operating room (OR). Labeled surgical caps have been proposed as a strategy to improve intraoperative communication and teamwork by facilitating name and role recognition among surgical staff. However, concerns regarding potential surgical site infections (SSIs) have limited their widespread adoption and to this day hindered their use across Europe. METHODS: The MEDLINE/PubMed database was searched for peer-reviewed articles reporting on the use of labeled surgical caps and at least one outcome of interest (communication, teamwork, surgical site infections, costs, or environmental impact) from database inception to April 2025. Findings were synthesized qualitatively. RESULTS: Reusable labeled surgical caps improve interdisciplinary communication and name recognition in the operating room, thereby promoting effective teamwork. This effect is particularly relevant in robotic surgery, where the primary surgeon operates from a remote console. Current evidence does not indicate an increased risk of SSIs, with multiple studies reporting no significant difference in infection rates between reusable and disposable surgical headwear. CONCLUSIONS: Reusable, labeled surgical caps should be implemented across the globe to improve communication and ultimately patient safety. They align with green hospital goals by reducing waste and long-term costs. Additionally, they also provide opportunity for stronger identification with the institution. Current regulations restricting their use are not supported by existing evidence and should be re-evaluated. Prospective studies also from European clinical settings may help to establish future policy updates and to further evaluate the microbiological safety of reusable surgical caps. </p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044050","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":"Validation of the new \"Brandenburg Acute Bile Duct (BABD) injury classification\" system in 106 patients with accidental bile duct injuries during cholecystectomy.","authors":"R Mantke, J Hafkesbrink, Paasch Ch, R Hunger","doi":"10.1186/s13037-025-00451-1","DOIUrl":"10.1186/s13037-025-00451-1","url":null,"abstract":"<p><strong>Background: </strong>Bile duct injuries following laparoscopic cholecystectomy are rare but serious complications. Timely diagnosis and optimal management remain challenging. Classification systems for bile duct injuries may facilitate diagnosis, guide treatment, and improve outcomes, however their clinical use is limited. This study systematically evaluated existing classification systems and assessed their applicability to all types of injuries. Based on this analysis, a new classification system for acute lesions was developed.</p><p><strong>Methods: </strong>The database of the German Arbitration Board for medical liability issues was queried to identify cases involving bile duct injuries following a cholecystectomy (1990-2021). For each patient, the anatomical location, extent of injury, and therapeutic approach were documented. Injuries were categorized according to 11 published classification systems and a newly developed classification system. The ability to categorize bile duct injuries of all systems was assessed.</p><p><strong>Results: </strong>A total of 106 bile duct injuries were identified. The common bile duct was the most frequently injured structure (31.1%), followed by combined injuries (27.4%), and injuries of the common hepatic duct (17.9%). In 13.2% of cases, an artery was injured in addition to the bile duct lesion. Only 30.2% of bile duct injuries were detected intraoperatively. The most frequently performed techniques were biliodigestive anastomosis (34.4%), direct bile duct anastomosis (31.3%), and leakage closure with stitches (28.1%). None of the 11 existing classifications could categorize all cases; the best-performing systems (Amsterdam, Hannover) classified 82-86%. In contrast, the new Brandenburg Acute Bile Duct Injury (BABD) Classification was able to categorize 99% of the injuries.</p><p><strong>Discussion: </strong>Current classification systems fail to categorize all acute bile duct injuries following cholecystectomies. The BABD Classification, which is based on the anatomical location and extent of injury, allows systematic categorization of all documented acute bile duct lesions and may improve diagnostic clarity, treatment planning, and comparability in future studies.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":" ","pages":"6"},"PeriodicalIF":2.1,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12857022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960446","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":"Root causes of surgical never-events: a systematic review.","authors":"Dilen Parmar, Neil Patel, Catherine Kenneth-Ogah, Sadat Yazdouni, Chaitya Desai, Dimit Raveshia, Ravi Patel","doi":"10.1186/s13037-025-00474-8","DOIUrl":"10.1186/s13037-025-00474-8","url":null,"abstract":"<p><p>BACKGROUND: Never-events represent serious and preventable patient safety incidents within surgical practice, despite increasing national and international efforts to reduce them. Persistent concerns regarding wrong site surgery, retained surgical items, and incorrect implants highlight the need to understand contributory human factors and system-level weaknesses. METHODS: A systematic search of PubMed/Medline, Google Scholar, and the Cochrane Library was conducted. Evidence published between 2014 and 2024 was screened according to predefined eligibility criteria to identify contemporary data relating to surgical never-events. Studies were assessed using standardised selection methods and relevant findings were extracted and synthesised. RESULTS: Thirty-seven studies met inclusion criteria. Across international literature, recurring contributory factors included communication breakdowns, reduced situational awareness, fatigue, inadequate staffing, inconsistent team composition, and increasing surgical caseloads. Despite advances in safety practices, these factors continued to contribute to adverse surgical outcomes. CONCLUSION: Never-events remain a persistent challenge in surgical care. Strengthening safety management systems, improving awareness of human factors, and prioritising non-technical skills training may help reduce the risk of these events. Ongoing evaluation of interventions and further UK-based research are required to support improvement in patient safety outcomes. </p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":" ","pages":"3"},"PeriodicalIF":3.3,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12857047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935434","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":"Predictors of complications after intramedullary nailing for lower extremity fractures in low-resource settings: a 10-year experience with the SIGN nail in Nigeria.","authors":"Stephen Adesope Adesina, Isaac Olusayo Amole, Adepeju Olatayo Adegoke, Chiwendu Uchechukwu Isiakpona, Chidiebube Enyeremchi Ukejianya, Sarah Michael-Duja, Imri Goodness Adefokun, Olusola Tunde Ekunnrin, Simeon Ayorinde Ojo, Innocent Chiedu Ikem, Samuel Uwale Eyesan","doi":"10.1186/s13037-025-00463-x","DOIUrl":"10.1186/s13037-025-00463-x","url":null,"abstract":"<p><strong>Background: </strong>In low-resource countries, the incidence of lower extremity long-bone fractures exceeds that in high-resource countries due to higher rates of motor vehicle collisions (MVCs). This situation is worsened by limited resources for adequate care, resulting in significant health and economic impacts. Locked intramedullary nailing (IMN) is a widely accepted treatment for lower extremity fractures, but it carries risks of complications, which have not been well-studied in low-resource settings. Considering the resource differences between high- and low-resource settings, local research is essential for identifying modifiable factors to prevent complications. This study investigated the predictors of complications after IMN with \"Surgical Implant Generation Network\" (SIGN) nails (Richland, WA, USA) for lower extremity fractures in a low-resource setting.</p><p><strong>Methods: </strong>A secondary analysis was performed on prospectively collected data from 666 fractures in 603 patients treated with SIGN nails at a mission teaching hospital in southwestern Nigeria between July 2014 and June 2024. The mean age was 43.2 years, and 65.7% of the patients were male. Fractures meeting the inclusion criteria were classified as with or without complications. Two-thirds (66.8%) were femur fractures, and 33. 2% were tibia fractures. Univariate and binary logistic regression analyses identified significant predictors of complications.</p><p><strong>Results: </strong>The overall complication rate was 11.7%, with infection and non- union being the most common. The mortality rate was 1.1%. Independent predictors of complications included injury mechanism (p = 0.033), fracture age (p = 0.003), fracture type (p < 0.001), prior treatment elsewhere (p = 0.007), and surgery duration (p = 0.004). Fractures resulting from MVCs, older fractures, and open fractures showed higher complication rates. Each additional 30 min of surgery increased the odds of complications by 34% (95% CI, 1.003-1.017).</p><p><strong>Conclusion: </strong>This study shows that IMN with SIGN nails is an effective treatment for fractures in low-resource settings. However, challenges remain, especially with open fractures and delayed treatment. Prioritizing timely surgery, improving infection control, and enhancing surgical efficiency are essential for better outcomes. The findings inform strategies for improvement and highlight the need for further research to develop evidence-based guidelines for IMN in low-resource environments.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"39"},"PeriodicalIF":2.1,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12752117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145858248","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":"Lessons learned from a decade of re-exploratory laparotomies in obstetrics and gynecology at a tertiary care hospital in Mumbai, India, 2014-2024.","authors":"Rashida Ali, Nimish Tutwala, Mena Abdalla","doi":"10.1186/s13037-025-00462-y","DOIUrl":"10.1186/s13037-025-00462-y","url":null,"abstract":"<p><strong>Background: </strong>Re-exploratory laparotomy in obstetrics and gynecology is a serious and challenging surgical event associated with significant morbidity and mortality. Understanding its incidence, indications, and outcomes is crucial for improving patient care and surgical safety. This study presents a comprehensive analysis of re-exploratory laparotomies over a 10-year period in a major tertiary care center.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on all patients who underwent re-exploratory laparotomy following obstetric or gynecological surgery between 2014 and 2024. Data on patient demographics, primary surgery, indications for re-exploration, time to re-intervention, procedures performed, and postoperative outcomes were collected and analyzed. Statistical analysis was performed using descriptive statistics, chi-square tests, and t-tests to identify significant associations.</p><p><strong>Results: </strong>A total of 117 cases of re-exploratory laparotomy were identified. The mean age of patients was 31.8 ± 7.0 years. The most common primary surgeries were Cesarean Sect. (46.2%) and total abdominal hysterectomy (23.1%). The leading indications for re-exploration were postpartum hemorrhage (26.5%), muscle hematoma (20.5%), and burst abdomen (17.1%). The mean time to re-exploration was 4.7 ± 2.7 days. The overall mortality rate was 8.5%, and the postoperative complication rate was 46.2%. No significant association was found between the level of emergency and patient outcome (p = 0.637).</p><p><strong>Conclusion: </strong>Re-exploratory laparotomy remains a critical event in obstetric and gynecological practice, with hemorrhage and postoperative wound complications being the primary drivers. This study highlights the need for meticulous surgical technique, early recognition of complications, and prompt intervention to improve patient outcomes. Further research is needed to identify high-risk patient groups and optimize management strategies.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"44"},"PeriodicalIF":2.1,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12751624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145858217","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}