Patient Safety in Surgery最新文献

{"title":"Development and evaluation of a novel voice-enabled prototype to support consistent application of surgical safety checklists: a proof-of-concept study.","authors":"Pedro Miguel Inácio Medroa, Marcel Saltan, Sandro-Michael Heining, Kerstin Denecke","doi":"10.1186/s13037-025-00460-0","DOIUrl":"10.1186/s13037-025-00460-0","url":null,"abstract":"<p><strong>Background: </strong>Surgical safety checklists are essential for reducing errors and improving outcomes, but consistent, full-phase adherence remains suboptimal. Traditional paper-based systems can disrupt workflow and limit team engagement. Voice-enabled solutions offer potential to improve compliance while preserving sterile conditions and communication flow in the operating room (OR).</p><p><strong>Methods: </strong>This study aimed to develop and evaluate a prototype voice-controlled digital assistant for surgical checklists - referred to as 'VoiceCheck' - with a focus on usability, technical performance, and feasibility in real-world clinical settings. VoiceCheck guides clinical teams through the \"Sign In\", \"Time-out\", and \"Sign Out\" phases of the surgical checklist using voice commands and speech transcription. The system operates offline, incorporating Rhasspy for intent recognition and Whisper for speech-to-text transcription. Twelve surgical team members participated in a field evaluation, completing structured tasks alongside routine workflows. Usability was assessed using the System Usability Scale (SUS) and a custom questionnaire. Technical evaluations tested Whisper V2 and V3 under quiet and noisy conditions, and Rhasspy's intent and wake word recognition across 1'125 commands in two environments (noisy, quiet).</p><p><strong>Results: </strong>Participants rated usability positively (SUS median score 76.04). Whisper V3 achieved 90.7-97.3% transcription accuracy, outperforming V2 in noisy settings. Rhasspy recognized intents with 92.8-94.8% accuracy and maintained a low false-positive rate. VoiceCheck functioned reliably offline and was preferred with a conference microphone for multi-user interaction.</p><p><strong>Conclusion: </strong>VoiceCheck demonstrates feasibility for voice-assisted checklist execution in surgical settings. It was well accepted by users and performed reliably under realistic conditions. Further research should explore clinical integration, workflow impact, and multilingual capabilities.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"38"},"PeriodicalIF":2.1,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12729816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828737","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":"Surgical interruptions and preventable delays in the operating rooms of academic teaching hospitals.","authors":"Reza Kalantari, Mehdi Hasanshahi, Somayeh Gheysari, Anahid Geramshahi","doi":"10.1186/s13037-025-00470-y","DOIUrl":"10.1186/s13037-025-00470-y","url":null,"abstract":"<p><p>BACKGROUND: Operating rooms are complex environments prone to delays and interruptions, which are linked to human error and adverse patient outcomes. Since more than half of the hospitals in Iran are teaching hospitals, understanding these delays and interruptions is crucial to prevent them. This observational study aimed to assess the lost time and causes for surgical interruptions and delays in Iranian academic teaching hospitals. METHODS: This cross-sectional observational study was conducted in five teaching hospitals in Iran during July and August of 2025. A total of 251 surgeries were randomly observed using full-case non-participant observation. Data were collected using a chronometer and standardized forms. Causes of delays and interruptions were categorized through directed content analysis. Quantitative data were analyzed with statistical package for social science (SPSS) version 24. The primary outcome was total lost time per surgery. The secondary outcomes were frequency and duration of interruptions and delays, as well as the distribution of causes. RESULTS: Out of 50,675 observed minutes, 7,920 min (16.83%, Confidence Interval 95%: 14.62–19.04) were lost due to interruptions and delays. A total of 281 delays with 319 causes were recorded and classified into five categories: operating room staff (172 times), staff outside the operating room (21), instruments and devices (60), patients (33), and managerial issues (33). Notably, 14.1% of causes were related to the educational nature of the hospitals, involving residents and trainees. CONCLUSIONS: Surgical interruptions and delays happen frequently and may reduce operating room efficiency and threaten patient safety. Delays related to residents and trainees require further investigation considering overall operating room efficiency. Educational, managerial, and instrument-related interventions may reduce lost operating room time. The findings may be generalizable to academic teaching hospitals. </p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":" ","pages":"41"},"PeriodicalIF":3.3,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12752449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145811768","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 opioid use disorder as a safety risk in elective total hip arthroplasty: an imperative for routine preoperative screening.","authors":"David Maman, Yaniv Steinfeld, Yaron Berkovich","doi":"10.1186/s13037-025-00469-5","DOIUrl":"10.1186/s13037-025-00469-5","url":null,"abstract":"<p><p>BACKGROUND: Total hip arthroplasty (THA) utilization is rising worldwide, but the concurrent opioid epidemic has introduced new perioperative safety challenges. Opioid use disorder (OUD) is a chronic relapsing condition that may complicate surgical management and increase preventable adverse events. METHODS: During the study period from January 1, 2016 to December 31, 2022, a total of 1,957,284 elective primary THA cases were identified in the National Inpatient Sample. Of these, 12,285 (0.6%) had a documented diagnosis of opioid use disorder (OUD). After 1:1 propensity score matching, 12,285 OUD cases were matched to 12,285 non-OUD controls with comparable baseline characteristics. RESULTS: Patients with OUD had significantly longer mean length of stay (p < 0.001), higher hospital charges (approximately 15% higher, p < 0.001), and increased rates of in-hospital postoperative complications compared with matched controls. CONCLUSIONS: Patients with OUD undergoing THA experience significantly worse inpatient outcomes and higher costs. These findings highlight OUD as a modifiable surgical-safety risk factor and support the implementation of routine preoperative OUD screening and optimization protocols to improve patient safety and resource utilization. </p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":" ","pages":"40"},"PeriodicalIF":3.3,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12752056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800787","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":"Awake sigmoidectomy under continuous spinal anesthesia in a high-risk ASA class V patient: a case report.","authors":"Henry Abumohor, Yara Taha, Seham Madaka, Majdi Hmamdeh, Ahmad Irzeiqat, Mohammed Maraqa","doi":"10.1186/s13037-025-00468-6","DOIUrl":"10.1186/s13037-025-00468-6","url":null,"abstract":"<p><strong>Background: </strong>Awake colorectal surgery is an alternative to general anesthesia, especially in high-risk patients with significant cardiopulmonary comorbidities. Continuous segmental spinal anesthesia offers stable intraoperative conditions while avoiding the complications of cardio depressant effects, airway manipulation and sedation. Despite its advantages, this approach remains underreported in major colorectal procedures.</p><p><strong>Case presentation: </strong>We present the case of a 73-year-old male with a history of ischemic cardiomyopathy, chronic heart failure (ejection fraction 25-30%), chronic kidney disease, and pulmonary complications, classified as American Society of Anesthesiologists (ASA) Risk Class V. The patient was admitted to a tertiary hospital in Palestine with a recurrent sigmoid volvulus, and due to the high risk associated with general anesthesia, the surgical, cardiology and anesthesia teams decided for an awake open sigmoidectomy under continuous segmental spinal anesthesia. The patient remained fully conscious and hemodynamically stable throughout the procedure. Postoperative recovery was uncomplicated apart from a superficial wound infection, which was managed conservatively. At six-month follow-up, the patient remained asymptomatic, tolerated a normal diet, had no recurrent bowel obstruction, and showed complete wound healing without late infectious or anastomotic complications.</p><p><strong>Conclusion: </strong>This case illustrates the feasibility, safety, and potential benefits of awake sigmoidectomy in fragile, multimorbid patients. To our knowledge, it represents the first reported case in Palestine. The successful outcome emphasizes the importance of advanced regional techniques and multidisciplinary collaboration in managing high-risk surgical patients, especially in settings with limited resources.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":" ","pages":"42"},"PeriodicalIF":2.1,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12751581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800797","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":"Retained fragmented Raytec gauze eluding an alleged correct postoperative count following cardiothoracic surgery: case report of a rare \"never event\".","authors":"Marco Lizwan, Philip Y K Pang","doi":"10.1186/s13037-025-00472-w","DOIUrl":"10.1186/s13037-025-00472-w","url":null,"abstract":"<p><strong>Introduction: </strong>Retained surgical items are rare yet serious complications that may occur despite correct instrument and sponge counts. Surgical sponges remain the most frequently retained items, with gauze marker strand retention being an uncommon mechanism.</p><p><strong>Case presentation: </strong>A 69-year-old male with severe mitral regurgitation and triple-vessel coronary artery disease underwent mitral valve replacement with coronary artery bypass grafting. All surgical counts were verified as correct at the conclusion of surgery. Postoperative chest radiography, however, revealed two linear radio-opaque foreign bodies near the left lower sternum. Mediastinal re-exploration identified two radio-opaque strands, measuring 3.0 cm and 2.0 cm, attached to the left lower chest wall near the internal mammary artery stump. These were confirmed to be detached marker strands from Raytec gauzes. The patient's recovery was uneventful and he was discharged well.</p><p><strong>Conclusion: </strong>This case illustrates that retained gauze fragments can occur despite correct counts due to fragmentation of radiopaque markers. Surgeons and operating room nurses should inspect gauzes for integrity, maintain vigilance when manipulating sponges in confined operative fields, and consider adjunct technologies such as radiofrequency or barcode tracking. In high-risk surgeries, postoperative imaging may be warranted even with accurate counts to ensure patient safety.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":" ","pages":"43"},"PeriodicalIF":2.1,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12750874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800750","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":"Chronic gossypiboma mimicking a peri-appendiceal abscess after prior Cesarean sections: a rare surgical \"never event\".","authors":"Jasser Rchidi, Ghazi Lâamiri, Hazem Beji, Oussama Mghirbi, Mahdi Bouassida, Hassen Touinsi","doi":"10.1186/s13037-025-00466-8","DOIUrl":"10.1186/s13037-025-00466-8","url":null,"abstract":"<p><p>BACKGROUND: Gossypiboma, a retained surgical sponge, is a rare but serious “never event.” It poses a significant diagnostic challenge due to its nonspecific and variable clinical presentation, which often mimics other conditions like intra-abdominal abscesses or tumors. CASE PRESENTATION: A 34-year-old woman with a history of two previous Cesarean sections presented with abdominal pain and vomiting. Physical examination revealed a firm, tender mass in the right iliac fossa. An ultrasound suggested a diagnosis of acute appendicitis with a peri-appendiceal abscess. During diagnostic laparoscopy, a large inflammatory mass adherent to the cecum and terminal ileum was found, leading to conversion to open laparotomy. The mass was excised and found to be a Gossypiboma; a retained surgical sponge encased in a thick fibrous capsule. An appendectomy was performed, and the patient had an uneventful postoperative recovery. CONCLUSION: This case underscores two critical points in clinical practice. First, a high index of suspicion for gossypiboma is essential in any patient with a prior surgical history who presents with an unexplained mass or pain, as it can mimic common conditions like complicated appendicitis. Second, and more importantly, this represents a profound failure in operative safety protocols. The occurrence of a retained surgical item is universally classified as a preventable “never event,” highlighting a breakdown in systematic safeguards rather than merely an individual error. The ultimate goal must be prevention through a multi-faceted strategy. This includes rigorous adherence to manual sponge counts, the integration of technological adjuncts such as radio-frequency tagged sponges, and the cultivation of a meticulous safety culture within the operating room to protect patients from this avoidable harm. </p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"37"},"PeriodicalIF":3.3,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12713281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783269","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":"Flawed design and selection bias in critical care randomized controlled trials (RCTs): the patient safety risk of the \"RCT mimic\".","authors":"Lawrence A Lynn","doi":"10.1186/s13037-025-00456-w","DOIUrl":"10.1186/s13037-025-00456-w","url":null,"abstract":"<p><p>Over three decades, randomized controlled trials (RCTs) for critical care syndromes such as acute respiratory distress syndrome (ARDS), sepsis, and community acquired pneumonia (CAP) have repeatedly produced non-reproducible results, at times leading to high-impact reversals of global protocols when later studies revealed harm. These trials enroll patients using expert-derived threshold sets intended to define the syndrome. This analytic review presents the first historical and formal methodological review and mathematical analysis of such RCT using causal symbolic modeling (cSM), directed acyclic graphs (DAGs), and do-calculus. The review includes landmark publications, task-force threshold sets, and case examples, including the 2025 REMAP-CAP corticosteroid domain, to model the causal structure of standard RCTs applied to threshold-defined syndromes. PubMed searches and ChatGPT were used to assist in this process. The historical inquiry uncovered that the critical care syndromes of ARDS and sepsis are guessed synthetic constructs, devised in the twentieth century by Thomas Petty and Roger Bone as heuristic groupings of diverse but similar appearing diseases. However a much more striking discovery was that Petty and Bone introduced a streamlined variant of the Bradford Hill RCT method, here termed the \"Petty-Bone RCT', which conditions enrollment on a triage threshold set that functions as a cohort-level collider. This design yields results valid only for the unstable mixture of diseases enrolled. The \"Petty-Bone RCT\" preserves the outward form of a randomized trial but lacks the causal structure needed for transportability, making it an RCT mimic. The cSM analysis in this review shows that while potentially internally valid, such trials cannot produce reliable treatment protocols and often cause harm. These findings compel the abandonment of the Petty-Bone RCT framework, the integration of cSM into the Consolidated Standards of Reporting Trials (CONSORT), and prioritizing mechanistically grounded, investigator-led designs in critical care research. These provocative discoveries indicate that not one more patient, not one more investigator, not one more grant should be sacrificed to the next iteration of a Petty and Bone's synthetic syndrome RCT.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"36"},"PeriodicalIF":2.1,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12709683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769511","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":"Unintentionally retained surgical gauze presenting as chronic infected fistula to the surgical wound: a report of two cases.","authors":"Jacques Fadhili Bake, Justin Kambale Tsandiraki, Céline Kavira Malengera, Fabrice Gulimwentuga Cikomola, Claude Kasereka Masumbuko, Zacharie Tsongo Kibendelwa, Dan Poenaru","doi":"10.1186/s13037-025-00464-w","DOIUrl":"10.1186/s13037-025-00464-w","url":null,"abstract":"<p><p>INTRODUCTION: Retained foreign objects represent a critical yet preventable failure in surgical safety systems worldwide, reflecting systemic weaknesses that threaten patient outcomes. Persistent postoperative fistulae are a potential clinical marker of such retained foreign objects, but they are often underrecognized, particularly in resource-limited settings. By reporting these cases, we aim to underscore the diagnostic value of wound fistulae as a sentinel sign of retained foreign objects and to highlight the ongoing gaps in surgical safety systems. CASE PRESENTATION: Two African females presented with chronic, non-healing wounds accompanied by persistent fistulous discharge following previous surgical procedures. The first patient, 46-year-old, experienced abdominal pain and ongoing wound discharge that persisted for five months after undergoing a hysterectomy. Diagnostic imaging identified a retained abdominal pack which had migrated into the bowel, resulting in both an enterocutaneous fistula and an interloop fistula. Accordingly, a revision laparotomy was performed four days post-presentation, entailing the removal of the retained abdominal pack along with segmental resection of the ileum followed by primary anastomosis. The second patient, 45-year-old, presented with persistent drainage from a neck wound six months after thyroidectomy, notwithstanding several unsuccessful wound explorations. Operative exploration carried out two days after presentation revealed retained gauze within a fistulous tract. In both instances, surgical extraction of the retained foreign objects led to complete resolution of symptoms. CONCLUSION: These cases expose the systemic deficiencies in operative safety that permit the occurrence of retained foreign objects, leading to severe patient harm and prolonged morbidity. They highlight the urgent need to reinforce surgical safety culture, ensure strict compliance with established checklists, and implement reliable detection protocols. Addressing these systemic gaps is essential to prevent such avoidable complications and improve patient safety outcomes globally. </p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":" ","pages":"35"},"PeriodicalIF":3.3,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12699898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640246","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":"Rare \"double tragedy\" and successful salvage strategy after failed bilateral humeral fracture fixation in a resource-constrained setting: a case report.","authors":"Stephen Adesope Adesina, Isaac Olusayo Amole, Adepeju Olatayo Adegoke, Oluwafemi Oyewole Oyewusi, Chidiebube Enyeremchi Ukejianya, Ibukun Adewumi Okunade, Imri Goodness Adefokun, Adewumi Ojeniyi Durodola, Simeon Ayorinde Ojo, Innocent Chiedu Ikem, Samuel Uwale Eyesan","doi":"10.1186/s13037-025-00459-7","DOIUrl":"10.1186/s13037-025-00459-7","url":null,"abstract":"<p><strong>Background: </strong>Bilateral humeral shaft fractures are rare injuries that present significant management challenges, particularly in resource-constrained settings. This case report highlights the complexities of treating bilateral humeral shaft fractures in a 40-year-old male patient from southwestern Nigeria, whose treatment was initially complicated by failed plate osteosyntheses. The objectives of this report are (1) to illustrate the unusual injury patterns that result from inadequate transportation infrastructure in developing countries, (2) to highlight the challenges patients and surgeons face in managing fractures in resource-constrained environments, and (3) to emphasize the critical role humanitarian organizations play in enhancing orthopedic care and achieving positive patient outcomes in these settings.</p><p><strong>Case presentation: </strong>A 40-year-old male patient, the primary earner for his family, presented to our facility three months after a road traffic crash with bilateral upper limb dysfunction. While driving with his seatbelt fastened, a trailer truck struck his car on the driver's side, resulting in bilateral closed humeral shaft fractures, a mild traumatic brain injury, and minor skin abrasions. Initial plate osteosynthesis at a private peripheral hospital failed, resulting in bilateral nonunions. Upon presentation at our facility, the patient had normal vital signs and preserved neurovascular function, but limited upper-limb mobility. He underwent staged treatment, which involved removal of the plates, Surgical Implant Generation Network (SIGN) nail (Richland, WA, USA) fixation, and cancellous autografting. Despite financial constraints and infection complications, both fractures achieved union and functional recovery after two years.</p><p><strong>Conclusions: </strong>This case underscores the challenges of managing complex orthopaedic trauma in low-resource settings, where inadequate healthcare infrastructure, limited access to suitable implants, and insufficient health insurance coverage exacerbate treatment difficulties. The successful outcome in this case was achieved through staged treatment, collaboration with the patient, and the use of donated SIGN nails. The report emphasizes the necessity for innovative solutions, collaborative efforts, and policy reforms to enhance fracture management outcomes and prevent long-term disabilities in resource-constrained settings. The role of humanitarian organizations in bridging the gap in orthopaedic care is also highlighted, demonstrating the potential for positive outcomes despite significant challenges.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"34"},"PeriodicalIF":2.1,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12661702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145641332","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 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}