Perioperative Care and Operating Room Management最新文献

{"title":"Postoperative pain control in patients in the post-anesthesia care unit: a prospective observational study","authors":"Carlos Alberto Henao Periañez ,&nbsp;Marcio Alexander Castillo-Díaz ,&nbsp;Monica Andrea Morales García","doi":"10.1016/j.pcorm.2025.100490","DOIUrl":"10.1016/j.pcorm.2025.100490","url":null,"abstract":"<div><h3>Purpose</h3><div>To analyze postoperative pain control in patients in the post-anesthesia care unit.</div></div><div><h3>Method</h3><div>This prospective observational study was conducted at a University Hospital in Minas Gerais, Brazil. Preoperative, intraoperative, and anesthesia recovery health information were considered for their association with postoperative pain control. Pain levels were measured using the verbal numeric scale (VNS, 0–10 points) from admission to discharge from the post-anesthesia care unit. The Pain Management Index (PMI, -3 to 3 points) assessed pain management adequacy. Descriptive statistics and an ordinal regression model identified associated factors, with a p-value &lt; 0.05 considered significant.</div></div><div><h3>Findings</h3><div>The sample consisted of 226 patients. Upon admission to the post-anesthesia care unit, 5.8 % of patients reported moderate to severe pain (VNS ≥ 4). According to PMI, Pain was adequately treated in 85.4 % of patients (PMI ≥ 0). However, at the time of discharge, 22.1 % of patients reported moderate to severe pain (VNS ≥ 4). Regression analysis showed that inadequate pain management (OR = 9.97, <em>p</em> &lt; 0.01) and the presence of anxiety or depression (OR = 3.89, <em>p</em> &lt; 0.01) significantly increased the odds of experiencing higher levels of pain. The coexistence of anxiety and depression was associated with a greater risk of high levels of pain (OR = 9.29, <em>p</em> &lt; 0.01). On the other hand, age (being older) was a protective factor (OR = 0.97, <em>p</em> = 0.046).</div></div><div><h3>Conclusion</h3><div>Our study found that a significant proportion of patients suffer moderate to severe postoperative pain. The results of this study may contribute to more effective postoperative care for patients with the risk factors identified in this research.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"39 ","pages":"Article 100490"},"PeriodicalIF":0.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143830122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterization of surgical flow disruptions in orthopedic surgery using a human factors approach","authors":"Asfandyar Khan ,&nbsp;Scott A. Shappell ,&nbsp;Albert J. Boquet","doi":"10.1016/j.pcorm.2025.100488","DOIUrl":"10.1016/j.pcorm.2025.100488","url":null,"abstract":"<div><h3>Background</h3><div>Efficient and safe perioperative care is critical to optimizing surgical outcomes and reducing preventable errors. Orthopedic procedures, ranging from minimally invasive techniques to complex surgeries, place significant cognitive and physical demands on surgical teams. Disruptions in workflow can compromise efficiency, coordination, and patient safety. This study aimed to systematically identify and categorize surgical flow disruptions to inform quality improvement efforts.</div></div><div><h3>Method</h3><div>Forty orthopedic surgeries were observed. A human factors taxonomy was used to classify disruptions, and descriptive statistical analysis was applied.</div></div><div><h3>Result</h3><div>Of the 2343 total disruptions observed, Interruptions (46.39 %) were the most frequent, followed by communication failures (33.25 %), coordination challenges (13.19 %), layout inefficiencies (5.25 %), equipment issues (1.20 %), and usability concerns (0.73 %). This translated into one disruption every 3.7 min for the 40 surgeries.</div></div><div><h3>Conclusions</h3><div>Addressing surgical flow disruptions proactively can enhance perioperative efficiency, safety, and team coordination. This study presents system vulnerabilities, enabling the possibility of shifting the focus from reactive error analysis to proactive mitigation strategies.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"39 ","pages":"Article 100488"},"PeriodicalIF":0.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of stress response, post-operative complications, and recovery between the enhanced recovery after surgery (ERAS) vs standard protocol in patients undergoing laparoscopic cholecystectomy: A prospective observational study from northern India","authors":"Mohd Danish ,&nbsp;Shubhajeet Roy ,&nbsp;Shiva Shiva ,&nbsp;Shailendra Pal Singh","doi":"10.1016/j.pcorm.2025.100489","DOIUrl":"10.1016/j.pcorm.2025.100489","url":null,"abstract":"<div><h3>Background</h3><div>The goal of the Enhanced Recovery After Surgery (ERAS) protocol is to reduce the surgical stress response to promote better postoperative recovery. Widespread adoption of the ERAS initiative has resulted in extending standards for various surgical specialties, especially in colorectal surgery. In this study, patients undergoing laparoscopic cholecystectomy had their perioperative stress response, postoperative problems, and rehabilitation assessed through a modified ERAS procedure.</div></div><div><h3>Methods</h3><div>120 patients were enrolled in a prospective observational research and randomly assigned to the ERAS (case) or standard treatment (control) groups. Important elements of the ERAS procedure were multimodal analgesia, carbohydrate loading, and preoperative education. Measurements of serum glucose, cortisol, total leukocyte count (TLC), and C-reactive protein (CRP) were performed both before and after surgery.</div></div><div><h3>Result</h3><div>The postoperative serum glucose and cortisol levels were significantly lower (<em>p</em> &lt; 0.001) in the ERAS group. Serum glucose levels in the ERAS group were greater 6 h after surgery and right before (<em>p</em> &lt; 0.001). Following surgery, the control group's serum cortisol levels were considerably higher (<em>p</em> &lt; 0.001). Additionally, the ERAS group experienced fewer problems at discharge, including fever (<em>p</em> = 0.01), vomiting (<em>p</em> = 0.004), and nausea (<em>p</em> = 0.03), and had lower PONV intensity scores at 24 h (<em>p</em> = 0.012). Furthermore, the ERAS group started oral feedings sooner and spent a considerably lower amount of time in the hospital (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>The modified ERAS protocol is beneficial in enhancing perioperative care and outcomes by reducing the surgical stress response and improving recovery in patients undergoing laparoscopic cholecystectomy.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"39 ","pages":"Article 100489"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143808089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Operating room nurses' perceptions of the missed perioperative nursing care in Iran medical science universities teaching hospitals: A cross-sectional nationwide survey","authors":"Omid Zadi ,&nbsp;Amirali Alizadeh ,&nbsp;Aysan judi ,&nbsp;Vahid Rahmani ,&nbsp;Nasrin Aghazadeh","doi":"10.1016/j.pcorm.2025.100487","DOIUrl":"10.1016/j.pcorm.2025.100487","url":null,"abstract":"<div><h3>Background</h3><div>Missed perioperative nursing care (MPNC) in operating rooms is a critical issue that can compromise patient safety and increase adverse events. Despite the importance of perioperative nurses' roles, limited research in Iran has focused on MPNC within the operating room environment. This study aimed to assess the prevalence and characteristics of MPNC among perioperative nurses in Iran.</div></div><div><h3>Methods</h3><div>This cross-sectional study was done on 733 perioperative nurses from August 2023 to January 2024. data were collected from teaching hospitals of the University of Medical Sciences across the country (20 teaching hospitals were randomly selected) using a multi-stage random stratified sampling method. Data were collected using the MPNC questionnaire developed by Marsch et al. After data collection, they were analyzed using SPSS24 with descriptive and inferential statistical tests.</div></div><div><h3>Results</h3><div>The overall MPNC mean score was 7.36 ± 6.3, indicating a low prevalence. Communication (mean: 0.27) and legal requirements (mean: 0.26) were the most frequently missed domains, while closure routines (mean: 0.15) were the least missed. Significant associations were observed between MPNC and demographic factors, including age (<em>P</em> = 0.013), work experience (<em>P</em> &lt; 0.001), and gender (<em>P</em> = 0.003). Commonly missed care included the use of venous stasis prevention devices and the proper signing of consent forms.</div></div><div><h3>Conclusions</h3><div>The study highlights critical gaps in perioperative nursing care, particularly in communication and legal documentation. Addressing these gaps through targeted training programs, workflow optimization, and adherence monitoring is essential to enhance patient safety and care quality in operating rooms.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"39 ","pages":"Article 100487"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143814816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative stress experiences of patients before surgical operation: A phenomenological study","authors":"Esra ÖZKAN ,&nbsp;Nurten Gülsüm BAYRAK ,&nbsp;Sevda UZUN","doi":"10.1016/j.pcorm.2025.100485","DOIUrl":"10.1016/j.pcorm.2025.100485","url":null,"abstract":"<div><h3>Aim</h3><div>The aim of this study was to evaluate patients' experiences of perioperative stress before surgery using a phenomenological approach.</div></div><div><h3>Design</h3><div>In the study, in which phenomenological research method was used, semi- structured in-depth interviews were conducted with 12 patients who were treated in the orthopedics clinic.</div></div><div><h3>Method</h3><div>Criterion sampling method, one of the purposive sampling methods, was used to reach the sample group. Interviews continued until data saturation was achieved. All interviews were recorded on a voice recorder after obtaining the necessary permissions and then transcribed. The data of the study were evaluated using thematic analysis. The study was conducted and reported according to the COREQ checklist.</div></div><div><h3>Results</h3><div>In the analysis of the data, three main themes (situations experienced before the surgical operation, feelings and thoughts about the operating room, and perioperative stress and thoughts about healthcare professionals) and seven sub-themes (mental, physical, social, emotions, thoughts, positive thoughts and negative thoughts) were identified.</div></div><div><h3>Conclusion</h3><div>It was found that patients experienced many psychosocial difficulties, especially fear and anxiety, in the preoperative period. It can be said that the difficulties experienced are related to both the surgical process and the operating room environment and the communication and interaction of healthcare professionals. In this context, determining the fear and anxiety levels of patients in the preoperative process, providing standardized comprehensive trainings to patients in order to prevent different practices related to the surgical process, organizing in-service trainings to strengthen the communication skills of healthcare professionals are very important for the healthy management of the process and providing holistic nursing care.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"39 ","pages":"Article 100485"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic value of using electronic transporter applications for post-anesthesia care unit staffing decisions rather than manual logging of transport durations","authors":"Paul Cover,&nbsp;Franklin Dexter","doi":"10.1016/j.pcorm.2025.100486","DOIUrl":"10.1016/j.pcorm.2025.100486","url":null,"abstract":"<div><h3>Background</h3><div>Recently, we used data from Epic's Rover Transport application to analyze patient discharges from a phase I post-anesthesia care unit (PACU). We perform a retrospective cohort study to analyze how and when to use transporter log data to appropriately balance Type I and Type II error rates in the context of PACU transporter staffing decision-making.</div></div><div><h3>Methods</h3><div>The Rover Transport app was used to track all PACU transports from July 2022 through April 2024, totaling 22,846 across 461 workdays. The total hours of PACU transport follow a trapezoidal pattern, with load increasing through the morning (08:00–11:59), plateauing in the afternoon and evening (12:00–15:59 and 16:00–19:59), and then decreasing at night (20:00–23:59). Each transporter spends approximately one hour per four-hour period transporting. To inform transporter staffing decisions from these data, pairwise comparisons were generated between each workday's “light” periods (08:00–11:59 vs 20:00–23:59) and “busy” periods (12:00–15:59 vs 16:00–19:59). The probability distribution of these pairwise comparisons were compared with normal distributions using Shapiro-Wilk tests and standardized normal probability plots. Then, for repeated statistical power analyses to guide PACU transporter staffing, Type II errors were considered at least as costly as Type I errors. Setting α = β = 0.05, we determined how many days of data were required to differentiate between the “light” periods (08:00–11:59 vs 20:00–23:59) and the “busy” periods (12:00–15:59 vs 16:00–19:59), using the minimum actionable difference of one hour per four-hour period.</div></div><div><h3>Results</h3><div>Both pairwise comparisons were normally distributed (Shapiro-Wilk <em>W</em> &gt; 0.99). At α=β=0.05, proper differentiation of hours of PACU transport workload between four-hour periods required total transport data from at least 18 out of every 100 workdays for the “light” four-hour periods, or 44 out of every 100 workdays for the “busy” four-hour periods. Relaxing the combined error rate to 0.15 reduced the day requirements to 36 and 15. Restricting the combined error rate to 0.02 required 80 and 32 days of data for comparison between “busy” and “light” four-hour periods respectively.</div></div><div><h3>Conclusions</h3><div>The number of days of data needed for statistically powerful comparisons between four-hour period workloads are prohibitively large for manual collection. Therefore, hospitals not yet using the transport tracking capabilities in their electronic medical records for PACU transports will benefit from using them, even if only for the improved staffing decisions the data allows.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"39 ","pages":"Article 100486"},"PeriodicalIF":0.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the safety patient and quality of care of the totally implantable venous access device process in oncology: An experience in a developing country tertiary university hospital","authors":"Kawtar Matrab ,&nbsp;Amine En-Naaoui ,&nbsp;Mohammed Sbabou ,&nbsp;Zoubida Khomsi ,&nbsp;Hafsa Bechar ,&nbsp;Hind Mimouni ,&nbsp;Agrad Khadija ,&nbsp;Sihame Lkhoyaali ,&nbsp;Banacer Himmi ,&nbsp;Saber Boutayeb","doi":"10.1016/j.pcorm.2025.100484","DOIUrl":"10.1016/j.pcorm.2025.100484","url":null,"abstract":"<div><h3>Background</h3><div>The totally implantable venous access device, named also the implantable chamber, is one of the most medical devices used in the oncological therapies. However, the process of implementing such devices provide several failure modes which decrease the quality of care and the enhance the risk of patient complications. For this reason, it is essential to develop an effective risk management plan enable to detect and reduce different associated risks in order to improve the quality and the safety processes in the totally implantable venous access device implementation activity.</div></div><div><h3>Methods</h3><div>The process of identification and assessment of risks is ensured using an adapted Failure Modes and Effects Analysis (FMEA) to the context of developing countries (application field is a Moroccan oncology university centre). Finally, the prioritization of corrective actions is calculated based on a proposed parameter (named the Priority Level) which takes into consideration developing countries constraints.</div></div><div><h3>Results</h3><div>The study of the totally implantable venous access device process leads to identify a large number of potential failures (n=72) which are divided in 3 classes (19 % intolerable, 51 % to be monitored; and 29 % of intolerable). Moreover, the adapted approach of FMEA proves high optimization of the project in terms of time and resources. An action program mapping is developed in order based on the Rik Priority Number and the Priority Level.</div></div><div><h3>Conclusion</h3><div>The implantable chamber poses a major challenge to any practitioner in oncology. This study constitutes the first experience in risk management of implantable chambers under developing countries constraints while highlighting all the failures to be prevented during their handling.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"39 ","pages":"Article 100484"},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Violation of the Monro-Kellie doctrine in paediatrics and perioperative anaesthetic concerns","authors":"Amarjeet Kumar,&nbsp;Kunal Singh,&nbsp;Chandni Sinha","doi":"10.1016/j.pcorm.2025.100460","DOIUrl":"10.1016/j.pcorm.2025.100460","url":null,"abstract":"","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"38 ","pages":"Article 100460"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143549776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Operating Room Management in Low-and-Middle Income Countries","authors":"Steven D. Boggs (Retired Chairman)","doi":"10.1016/j.pcorm.2025.100476","DOIUrl":"10.1016/j.pcorm.2025.100476","url":null,"abstract":"","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"38 ","pages":"Article 100476"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143550539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the characteristics of sedation using target-controlled infusion and manual infusion of propofol in patients undergoing lower limb surgery under spinal anaesthesia; a randomised controlled trial","authors":"Pinki Kumari,&nbsp;Anju R. Bhalotra,&nbsp;Rahil Singh,&nbsp;Mona Arya,&nbsp;Shweta Dhiman","doi":"10.1016/j.pcorm.2025.100482","DOIUrl":"10.1016/j.pcorm.2025.100482","url":null,"abstract":"<div><h3>Background</h3><div>Conscious sedation during spinal anaesthesia can be achieved by administering propofol using manual controlled infusions (MPI) or target-controlled infusions (TCI). We compared the characteristics of sedation with propofol administered by MPI and TCI in patients undergoing lower limb surgery under spinal anaesthesia.</div></div><div><h3>Methods</h3><div>A total of 60 patients aged 18–60 years with American Society of Anaesthesiologists physical status 1 and 2 who were scheduled for elective lower limb surgery of an anticipated duration of 1–2 h under spinal anaesthesia were enrolled. Participants were randomly allocated in 1:1 to either Group TCI or Group MPI to receive propofol sedation to maintain OAA/S 3. The primary outcome measure was the recovery time. Secondary outcomes were time to reach the desired level of sedation (OAA/S 3) and the total dose of propofol consumed.</div></div><div><h3>Main results</h3><div>The mean recovery time was 6.23 ± 1.63 min in the TCI group and 7.30 ± 1.44 min in the MPI group (<em>p</em> = 0.010). The total dose of propofol used in the TCI group (230.07 ± 83.77) was significantly higher than in the MPI group (162.33 ± 62.29) with a <em>p</em> = 0.001. A very strong positive correlation was observed between OAA/S and BIS in the TCI group (<em>r</em> = 0.969) as well as in the MPI group (<em>r</em> = 0.955) with a <em>p</em> &lt; 0.001.</div></div><div><h3>Conclusion</h3><div>With the study design employed, TCI was associated with a faster recovery and MPI with less propofol consumption. There was a high correlation between OAA/S and BIS values.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"39 ","pages":"Article 100482"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143580101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}