The value of the dedicated orthopaedic trauma operating room

BACKGROUND: Trauma centers and orthopaedic surgeons have traditionally been faced with limited operating room (OR) availability for fracture surgery. Orthopaedic trauma cases are often waitlisted and done late at night. We investigated the feasibility of having an unbooked orthopaedic trauma OR to reduce nighttime cases and improve OR flow. METHODS: A retrospective analysis was performed for two 1 year time periods before and after the introduction of an unbooked trauma OR. The unbooked trauma OR is kept open for urgent and semi-urgent cases from 7:45 am to 5 pm 6 days per week, and is under the control of Orthopaedics; no elective cases are scheduled in the unbooked trauma room.We collected OR time data on two common surgical cases (dynamic hip screw and closed femoral nailing) done before and after introduction of the unbooked orthopaedic trauma OR. We also reviewed data on waitlist cases, surgical time, anesthetic times, OR utilization, and surgical complications before and after the introduction of the unbooked trauma room. RESULTS: The availability of the unbooked trauma OR significantly improved operating suite flow. The proportion of hip fractures done after 5 pm was reduced by 72% (p<0.01). The number of all orthopaedic waitlist cases started after 5 pm was reduced by 6% (p<0.021). The distinct shift toward performing add-on cases during daytime hours resulted in a 6% reduction in OR over-utilization. Closed femoral nailing done at night required significantly more OR time (261 minutes versus 219 minutes, p<0.04). Hip fracture surgeries and femoral nailings done at night were noted to have a higher incidence of surgical complications (p<0.04 and p<0.036). CONCLUSION: The availability of an unbooked orthopaedic trauma room resulted in a measurable shift from performing "add-on" cases to daytime surgery and may reduce complications. We recommend that hospitals and orthopaedic trauma services commit resources toward having an open OR reserved for orthopaedic trauma.     

Radiation safety for anaesthesia providers in the orthopaedic operating room

In many orthopaedic operating rooms, anaesthesia providers routinely wear lead aprons for protection from radiation, but some studies have questioned whether this is needed. We conducted a systematic review to identify studies that measured the amount of radiation that anaesthetists were exposed to in the orthopaedic operating room. Multiple studies have shown that at 1.5 m from the source of radiation, anaesthetists received no radiation, or amounts so small that a person would have to be present in an unreasonable number of operations to receive cumulative doses of any significance. Radiation doses at this distance were often at the limits of the sensitivity of the measuring dosimeter. We question the need to wear lead protection for anaesthesia providers who are routinely at 1.5 m or a greater distance from standard fluoroscopy units.     

External fixation. Historic review, advantages, disadvantages, complications, and indications

The immobilization of fracture fragments by the insertion of pins connected externally by plaster, metal devices, or other appliances is not a new concept. In the past two centuries external fixation has enjoyed long periods of enthusiastic use alternating with intervals of total disrepute.     

Non-technical skills for surgeons in the operating room: a review of the literature

BACKGROUND: This review examines the surgical and psychological literature on surgeons' intraoperative non-technical skills. These are the critical cognitive and interpersonal skills that complement surgeons' technical abilities. The objectives of this paper are (1) to identify the non-technical skills required by surgeons in the operating room and (2) assess the behavioral marker systems that have been developed for rating surgeons' non-technical skills. METHODS: A literature search was conducted against a set of inclusion criteria. Databases searched included BioMed Central, Medline, EDINA BIOSIS, Web-of-Knowledge, PsychLit, and ScienceDirect. RESULTS: A number of "core" categories of non-technical skills were identified from 4 sources of data: questionnaire and interview studies, observational studies, adverse event analyses, and the surgical education/competence assessment literature. The main skill categories were communication, teamwork, leadership, and decision making. The existing frameworks used to measure surgeons' non-technical skills were found to be deficient in terms of either their psychometric properties or suitability for rating the full range of skills in individual surgeons. CONCLUSIONS: Further work is required to develop a valid taxonomy of individual surgeons' non-technical skills for training and feedback.     

音乐疗法在手术室应用研究的文献分析

目的分析音乐疗法在手术室应用现状,了解研究中尚存在的问题。方法以"手术室"、"音乐"为关键词,检索2004年6月至2010年5月三大全文数据库收录的期刊上关于音乐疗法应用于手术室的研究文献,对采用了随机对照实验的32篇文献进行分析。结果 32篇文献中,耳机音乐干预13篇,背景音乐干预19篇;涉及到局麻、硬膜外麻醉、腰麻等非全身性麻醉方式,包括子宫、甲状腺、乳腺、眼部等中小型手术。文献证实,音乐疗法可以稳定手术患者的心率、血压;能减轻疼痛,缓解焦虑症状。音乐疗法的干预方式及音乐种类选择存在差异,效果评价标准不一。结论音乐疗法的干预方式及音乐种类选择存在较大的不同;效果评价标准不一降低了同类研究的横向和纵向可比性。可从严格的实验设计、客观的评价指标、可控的干预技术、标准的实施方案等方面进行更深入研究。     

Intraoperative cholangiography in videolaparoscopic cholecystectomy: indications,advantages, and limitations

Consensus doesn't exist about the intraoperative cholangiography specially if is need in every one laparoscopic cholecystectomy either exclusively in case of anatomical doubts or suspect of injures or stones of the common duct. We have considered 450 patient subjected to laparoscopic cholecystectomy during 1992-2000. Patients suspicious to be affected by common duct lithiasis (28 cases) are subjected to ERCP with cleaning of the biliary tree. In 18 patients (4%) it has been necessary the laparotomic conversion; 176 patients (39%) have been subjected to intraoperative cholangiography, selected on anatomical regional disposition or anamnesis and biochemical and instrumental results (history of jaundice or gallstones pancreatitis, abnormal serum level of the biliary stasis biochemistry, common bile duct major of 8 mm, michrolitiasis of the gallbladder). In 7 cases (4%) we have discovered common bile duct stones. We don't attempt intraoperative cholangiography in every one laparoscopic cholecystectomy, but only in cases where we suspect presence of common bile duct stones either iatrogenic injuries or when we retain it necessary to clarify the regional anatomy. Unlikely just in patients where would be more useful, causes major risk of intra- and post-operative complications, it is very difficult, often impossible, to attempt the intraoperative cholangiography. Routinary employing of the intraoperative cholangiography could be useful just for a little number of patients, while selective employing reduce 60% the X-ray. Collaboration with the radiologist is able to reduce the mistaken on the interpretation of the radiograms.     

一体化手术室肺结节精准诊疗现状：系统性回顾研究

目的探讨一体化手术室对肺结节诊疗的安全性、可行性及有效性。 方法纳入广州医科大学附属第一医院胸外科2019年1月至2022年3月212例肺结节患者。全组病例均由同一团队麻醉医师和胸外科医师在一体化手术室完成电磁导航肺结节精确定位和单孔胸腔镜精准切除，手术均于自主呼吸麻醉下完成。收集并分析患者的肺结节定位配准时间、术程导航时间、定位成功率、切除范围、术后并发症等围手术期资料，对相关数据进行统计分析。 结果共212例患者，256个肺结节。运用电磁导航技术对肺结节进行定位，校准时间为（0.82±0.40）min，导航定位时间为（10.22±5.94）min。全组256个"靶区"肺结节，254（99.22%）个结节导航定位成功。全组患者均于电磁导航定位后行单孔胸腔镜手术，其中亚肺叶切除247例，占96.48%，肺叶切除9例，占3.52%。所有"靶区"肺结节均完整切除，切缘均为阴性。全组无出现严重并发症或死亡。术后住院时间为（1.92±0.87）d。 结论电磁导航肺结节定位，结合"无管化"自主呼吸麻醉和单孔胸腔镜切除术的优化与整合，为肺结节患者提供了一体化手术室诊疗，安全、精准、高效，值得推广。     

Teamwork in the operating room: frontline perspectives among hospitals and operating room personnel

BACKGROUND: The Joint Commission on Accreditation of Healthcare Organizations is proposing that hospitals measure culture beginning in 2007. However, a reliable and widely used measurement tool for the operating room (OR) setting does not currently exist. METHODS: OR personnel in 60 US hospitals were surveyed using the Safety Attitudes Questionnaire. The teamwork climate domain of the survey uses six items about difficulty speaking up, conflict resolution, physician-nurse collaboration, feeling supported by others, asking questions, and heeding nurse input. To justify grouping individual-level responses to a single score at each hospital OR level, the authors used a multilevel confirmatory factor analysis, intraclass correlations, within-group interrater reliability, and Cronbach's alpha. To detect differences at the hospital OR level and by caregiver type, the authors used multivariate analysis of variance (items) and analysis of variance (scale). RESULTS: The response rate was 77.1%. There was robust evidence for grouping individual-level respondents to the hospital OR level using the diverse set of statistical tests, e.g., Comparative Fit Index = 0.99, root mean squared error of approximation = 0.05, and acceptable intraclasss correlations, within-group interrater reliability values, and Cronbach's alpha = 0.79. Teamwork climate differed significantly by hospital (F59, 1,911 = 4.06, P < 0.001) and OR caregiver type (F4, 1,911 = 9.96, P < 0.001). CONCLUSIONS: Rigorous assessment of teamwork climate is possible using this psychometrically sound teamwork climate scale. This tool and initial benchmarks allow others to compare their teamwork climate to national means, in an effort to focus more on what excellent surgical teams do well.     

信息化技术在手术室管理中的应用进展

手术室管理信息化技术主要包括护理管理信息系统和临床护理信息系统,现已用于手术患者安全管理,手术室用物及仪器设备管理,护士管理及手术间调度。提出健全手术室大数据平台,利用人工智能深度挖掘数据,建立信息防护系统,培养综合型人才等,以进一步完善智能信息化手术室,为患者提供高水准的手术护理服务。     

The development of operating tables

Operating tables evolved in several stages. The most dynamic period was situated between 1860 and 1920: the surgeons of numerous countries were conscious of the necessity of specific tables for surgery. Introduction of anaesthesia in 1846 and asepsis in 1870 have strongly allowed this development.     

Nocturnal orthopaedic operating: can we let sleeping orthopaedic surgeons lie?

A 12-month retrospective study of emergency orthopaedic operations in a district general hospital was performed. There were 962 emergency admissions of whom 272 (17.7%) underwent emergency operation. The largest group consisted of those undergoing operation for femoral neck fractures (37.6% of the total). Despite 58.8% of the patients presenting to the accident and emergency (A&E) department between 0800 and 1700 hours, the majority (66.2%) were operated on ''out-of-hours''. Those patients undergoing emergency operation out-of-hours were allocated to one of three categories (emergency, urgent, or scheduled) depending on the nature and severity of their presenting condition. In the authors'' opinion, 81.9% of the patients could have been appropriately classified as scheduled cases and that all out-of-hours operating in this group of patients could have been deferred until the following morning. This would have reduced the number of orthopaedic operations performed out-of-hours from 182 to 33. The operating time at night would have been reduced from 126.9 h to 15.8 h. The implications of this study are important in view of the currently proposed changes in the hours worked by surgical trainees, the CEPOD findings, and the Government''s proposals outlined in Achieving a Balance.