Patient Safety in Surgery最新文献

{"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":"<p><p>Artificial intelligence (AI) and machine learning (ML) are increasingly being used in surgical care; however, their real-world impact on patient safety is not well established. This narrative review searched PubMed, Scopus, and Google Scholar for English-language studies published from January 1, 2015, to April 30, 2025, that evaluated AI and ML applications in complex surgery and reported quantitative patient safety outcomes. Eligible included studies were published between 2016 and 2025. In total, 21 studies were synthesized across the preoperative, intraoperative, and postoperative phases of the study. Preoperatively, ML models consistently outperformed traditional risk scores in identifying high-risk patients and anticipating technical difficulties. Intraoperatively, AI-enabled decision support reduced hypotension exposure in a randomized trial, and computer vision systems supported the safety-critical step verification and instrument tracking. Postoperatively, multimodal approaches combining electronic records, imaging, and smartphone wound photographs predicted complications, such as surgical site infection, and facilitated discharge planning. Emerging evidence from ambulatory surgery, imaging-guided triage, and specialty domains, alongside qualitative studies on workforce readiness, highlights implementation opportunities and human factor requirements. Most evidence is retrospective, single-center, or prototype stage with limited external validation and uncertain generalizability across settings, including low- and middle-income countries. Priorities include multicenter prospective trials, standardized outcomes and reporting, continuous bias and model drift monitoring, robust data infrastructure, and equity-focused implementation to translate algorithmic performance into fewer complications, deaths, and costs.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"33"},"PeriodicalIF":3.3,"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":"<p><p>BACKGROUND: Emerging data suggests present day surgeons coming out of training are treating fewer pelvic and acetabular injuries in practice than their predecessors. Few studies have investigated the acute effects of this in the perioperative setting, despite the critical condition of many of these patients. Accordingly, there is a need now for studies that examine how surgeon experience affects short-term outcomes in this patient population. METHODS: This is a retrospective cohort performed at a level I trauma center at UCSF- Fresno. Patients who underwent operative fixation for pelvic and/or acetabular fractures treated by a single fellowship-trained orthopaedic trauma surgeon year 1 through year 7 in practice were included. Electronic medical records were retrospectively reviewed for data collection. Yearly time points for surgeon experience were defined and compared. The primary outcome was acute surgical complications within six weeks. Secondary outcome measurements were estimated blood loss (EBL), operative time, transfusion requirements, and unplanned re-operation. RESULTS: Two hundred and six patients met study criteria. There was a significant difference in complications during year 1 versus after year 1: 16.7% and 4.5%, respectively (p = 0.026), and between years 1–2 and after year 2, 13.3% and 3.4%, respectively, (p = 0.022). There was no difference in complications after 2 years. Average operative time in the first year was 271.5 minutes, whereas average operative time for years 2-7 was 185.1 minutes (p=0.016). This difference remained significant until after year 4. There was a significant difference in estimated blood loss (EBL) between post-training years 0-2 and years 2+: 505.5 mL and 263.6 mL, respectively (p = 0.039). There was a significance difference in EBL between years 0-3 versus years 3+. There was no statistically significant difference after this. There was no difference in transfusions received or unplanned re-operations at all time points. CONCLUSIONS: There was no difference in complications at most time points. Despite statistically significant decreases in operative times and blood loss over the first five years in practice, pelvis and acetabular surgeries were shown to have significant blood loss and surgical time regardless of experience. Furthermore, there were no differences in transfusions and unplanned re-operations at all time points, suggesting that fellowship-trained surgeons in high-volume centers can safely treat these complex procedures without a clinically significant increase in morbidity early in their careers. </p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"32"},"PeriodicalIF":3.3,"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":"<p><p>BACKGROUND: Critical illnesses such as sepsis, trauma, and multi-organ failure initiate complex molecular cascades that disrupt cellular homeostasis and contribute to poor outcomes. Key among these mediators are Nicotinamide Adenine Dinucleotide (NAD+/NADH), Nitric Oxide (NO), and Hypoxia-Inducible Factor 1-alpha (HIF1α), each playing crucial roles in redox regulation, immune modulation, and tissue adaptation to hypoxia. REVIEW: This review examines the individual and interrelated roles of NAD+, NO, and HIF1α in critically ill patients. We explore how imbalances in NAD+/NADH ratio impair mitochondrial metabolism, how dysregulated NO signaling alters vascular tone and immune responses, and how HIF1α stabilization governs transcriptional programs under hypoxia. By mapping the biochemical crosstalk among these molecules, we identify potential feedback loops that influence inflammation, cellular energetics, and patient outcomes. A central theme is the safety and therapeutic relevance of modulating these mediators, with specific focus on the timing, context, and molecular profile of patients in critical care. CONCLUSION: Understanding the dynamic interplay among NAD+, NO, and HIF1α offers new opportunities for precision medicine in critical illness. We propose a hypothesis that phase-specific modulation of these pathways—through NAD+ precursors, NO donors/scavengers, or HIF1α stabilizers—could improve outcomes if guided by real-time molecular profiling. Prioritizing patient safety through targeted, biomarker-informed interventions may prevent progression to multi-organ failure and enable more personalized and effective treatments. </p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"30"},"PeriodicalIF":3.3,"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":"<p><p>BACKGROUND: Wearable sensors enable objective, non-invasive and accurate measurement of surgeons’ physiological parameters that potentially impact surgeon performance and patient outcomes. This scoping review aimed to explore studies measuring surgeons’ sleep, stress or physical activity using wearable sensors and to identify research gaps. METHODS: A systematic search of PubMed and Scopus was conducted following PRISMA-ScR guidelines, for English-language articles published from January 1, 1950 to June 1, 2025. We included original quantitative studies measuring sleep, stress or physical activity in practicing or training surgeons, either as a parameter to investigate, or a determinant of performance. Data on physiological parameters, surgeon and surgical procedure, operating room (OR) setting, performance, study design, objectives, and findings were extracted using a predefined form. RESULTS: Among 100 included studies, 88 measured stress, 9 sleep, and 5 physical activity. Stress was primarily assessed intraoperatively while sleep and physical activity during extended period inside/outside the OR. Most studies investigated the relationship between physiological parameters and surgeon attributes or within team role (43%), patient or surgical procedure (32%), OR setting, specific changes, or methods (17%). Six studies (6%) examined stress-performance links, with conflicting findings. Three studies (3%) suggested poor sleep may increase medical error risk, with inconsistent conclusions on burnout. Only one study quantified the influence of these parameters on patient outcomes. CONCLUSION: Tangible evidence linking surgeons’ physiological parameters and performance in the OR remains limited. Available sensor technologies nowadays represent emerging opportunities to close this gap and improve understanding of how surgeon-related human factors impact patient safety. </p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"27"},"PeriodicalIF":3.3,"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}

{"title":"Viewing patient safety in surgery through the lens of a theatrical performance: a narrative review.","authors":"Saeid Amini Rarani","doi":"10.1186/s13037-025-00448-w","DOIUrl":"10.1186/s13037-025-00448-w","url":null,"abstract":"<p><strong>Background: </strong>In the high-stakes environment of the operating room (OR), patient safety depends not only on technical expertise but also on seamless communication, clear roles, and coordinated teamwork. Traditional approaches often overlook the relational and performative dimensions of surgical care.</p><p><strong>Methods: </strong>This narrative article proposes a metaphorical framework that compares surgical practice to live theater, where each team member plays a rehearsed role, and protocols act as scripts. The study explores key themes such as preparation (rehearsals), intraoperative coordination (live performance), and structured debriefing (curtain call). The aim is to synthesize knowledge from clinical literature and human factors theory to provide a novel interpretive framework for improving patient safety in the operating room (OR). A selective literature review was conducted focusing on peer-reviewed publications related to surgical teamwork, communication, safety checklists, and non-technical skills. Sources were identified through PubMed and Google Scholar using relevant terms such as \"surgical safety,\" \"human factors in surgery,\" and \"team communication.\"</p><p><strong>Results: </strong>The metaphorical framework reveals that each member of the OR team-from the surgeon to the scrub nurse-is reimagined as a theatrical role, with their contribution being essential to the surgical outcome. Key concepts such as simulation training, checklists, psychological safety, and mutual accountability are highlighted as critical tools for enhancing performance and reducing preventable harm. The study emphasizes the importance of clear role definitions, team coordination, and continuous learning, similar to a theater production's preparation, performance, and reflection stages.</p><p><strong>Conclusion: </strong>Viewing the OR through the lens of theater offers a novel, human-centered model for improving surgical safety. This conceptual framework promotes structured teamwork, shared mental models, and a culture where every action is intentional and every role is respected ensuring that each surgical performance prioritizes the patient's well-being above all.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"23"},"PeriodicalIF":2.1,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12403911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973830","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}