1
|
Abramson HG, Curry EJ, Mess G, Thombre R, Kempski-Leadingham KM, Mistry S, Somanathan S, Roy L, Abu-Bonsrah N, Coles G, Doloff JC, Brem H, Theodore N, Huang J, Manbachi A. Automatic detection of foreign body objects in neurosurgery using a deep learning approach on intraoperative ultrasound images: From animal models to first in-human testing. Front Surg 2022; 9:1040066. [DOI: 10.3389/fsurg.2022.1040066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/18/2022] [Indexed: 12/03/2022] Open
Abstract
Objects accidentally left behind in the brain following neurosurgical procedures may lead to life-threatening health complications and invasive reoperation. One of the most commonly retained surgical items is the cotton ball, which absorbs blood to clear the surgeon’s field of view yet in the process becomes visually indistinguishable from the brain parenchyma. However, using ultrasound imaging, the different acoustic properties of cotton and brain tissue result in two discernible materials. In this study, we created a fully automated foreign body object tracking algorithm that integrates into the clinical workflow to detect and localize retained cotton balls in the brain. This deep learning algorithm uses a custom convolutional neural network and achieves 99% accuracy, sensitivity, and specificity, and surpasses other comparable algorithms. Furthermore, the trained algorithm was implemented into web and smartphone applications with the ability to detect one cotton ball in an uploaded ultrasound image in under half of a second. This study also highlights the first use of a foreign body object detection algorithm using real in-human datasets, showing its ability to prevent accidental foreign body retention in a translational setting.
Collapse
|
2
|
Vicente-Guijarro J, Valencia-Martín JL, Fernández-Herreruela C, Sousa P, Mira Solves JJ, Aranaz-Andrés JM. Surgical Error Compensation Claims as a Patient Safety Indicator: Causes and Economic Consequences in the Murcia Health System, 2002 to 2018. J Patient Saf 2022; 18:276-286. [PMID: 35503970 PMCID: PMC9162075 DOI: 10.1097/pts.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Compensation claims are a useful source of information on patient safety research. The purpose of this study was to determine the main causes of surgical compensation claims and their financial impact on the health system. METHODS A descriptive observational study with analytical components was carried out on compensation claims brought against the surgical area of the Murcia Health System between 2002 and 2018. We analyzed the frequency, causes, consequences, locations and surgical settings of these claims, the time of judicial procedure, and compensation adjusted to the Consumer Price Index. RESULTS There were 1172 compensation claims. "orthopedic surgery and traumatology" (27.4%), "gynecology and obstetrics" (25.7%), and "general surgery" (17.2%) were the main surgical settings involved. The most frequent causes were surgical error (42.4%) and treatment error (30.9%). The main sequelae were musculoskeletal (20.0%), neurological (17.7%), and obstetric (17.7%). The average time from incident to resolution of claims was 6.3 years. A total of 20.1% of these claims were successful, particularly those involving retained surgical foreign bodies (71.4% successful claims; P < 0.001). The total compensation paid was €56,338,247 (an average of €17,207 per claim). Compensation was higher in cases with respiratory sequelae (median, 131,600; P = 0.033), death (75,916; P < 0.001), and neurological (60,000; P = 0.024). CONCLUSIONS Compensation claims associated with surgical procedures are made on a variety of grounds. They are drawn-out proceedings, and patients are only successful in 20% of cases.
Collapse
Affiliation(s)
- Jorge Vicente-Guijarro
- From the Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina, Universidad de Alcalá, Acalá de Henares
- Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, Madrid
| | - José Lorenzo Valencia-Martín
- Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, Madrid
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen del Rocío, Sevilla
| | - Carlos Fernández-Herreruela
- Dirección Asistencial Noroeste, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud
- Perito Médico de Seguros, Asesor en Gestión de Riesgos Sanitarios, Madrid, Spain
| | - Paulo Sousa
- NOVA National School of Public Health, Universidade NOVA de Lisboa
- Comprehensive Health Research Centre (CHRC), Lisbon, Portugal
| | - José Joaquín Mira Solves
- Health Psychology Department, Miguel Hernández University, Elche
- Alicante-Sant Joan Health District, Consellería Sanitat, Alicante
- REDISSEC, Health Services Network Oriented to Chronic Diseases
| | - Jesús María Aranaz-Andrés
- From the Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS
- Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, Madrid
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | |
Collapse
|
3
|
Geeroms M, Pai A, Ceuterick B, Kapila A. Is the Systematic Sponge Count an Impediment to Patient Care During Plastic Surgical Procedures? PLASTIC AND AESTHETIC NURSING 2022; 42:103-110. [PMID: 36450091 DOI: 10.1097/psn.0000000000000433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Nurses and surgeons collaborate to conduct safe surgery. We follow time-consuming and labor-intensive protocols, such as the systematic counting and verifying of surgical sponges. However, the counting process may be distracting from other patient-centered tasks. To understand the perception of plastic surgery professionals about the intraoperative sponge count, we designed an online questionnaire. One hundred plastic surgeons and residents from 32 different countries completed the survey. The results showed that most often (70%) the scrub person determines when sponges will be counted, and 34.3% of the time, a sponge count is incorrect at the first count and then corrected. The main reason for an incorrect sponge count appears to be a change in personnel (53%). Radiological imaging is required during an average of 8.7% of surgeries to rule out a retained sponge in the patient. Notably, missing sponges are most frequently found elsewhere in the operating room. Younger surgeons prefer to pause during the surgical procedure until the sponge count is completed and noted to be correct. This approach appears to be associated with fewer counting errors, a shorter counting time, and a significant reduction in distraction of the whole surgical team. Performing a cavity sweep before beginning wound closure and using large surgical sponges are also suggested as alternatives to counting sponges. A sponge count can become an impediment to patient care because it has limited reliability and causes distraction among the team. A surgical pause can be implemented until the sponge count is completed or until any discrepancy is resolved.
Collapse
Affiliation(s)
- Maxim Geeroms
- Maxim Geeroms, MD, PhD, is a plastic, reconstructive, and aesthetic surgeon in private practice, Brussels, Belgium
- Ashwin Pai, MD, FRCS (Plast), is a plastic, reconstructive, and aesthetic surgeon, Wexham Park Hospital, Slough, United Kingdom
- Brecht Ceuterick, RN, is a perioperative nurse, Universitair Ziekenhuis, Brussels, Belgium
- Ayush Kapila, MD, MRCS, is a plastic surgery resident at the University of Brussels (VUB), Brussels, Belgium
| | - Ashwin Pai
- Maxim Geeroms, MD, PhD, is a plastic, reconstructive, and aesthetic surgeon in private practice, Brussels, Belgium
- Ashwin Pai, MD, FRCS (Plast), is a plastic, reconstructive, and aesthetic surgeon, Wexham Park Hospital, Slough, United Kingdom
- Brecht Ceuterick, RN, is a perioperative nurse, Universitair Ziekenhuis, Brussels, Belgium
- Ayush Kapila, MD, MRCS, is a plastic surgery resident at the University of Brussels (VUB), Brussels, Belgium
| | - Brecht Ceuterick
- Maxim Geeroms, MD, PhD, is a plastic, reconstructive, and aesthetic surgeon in private practice, Brussels, Belgium
- Ashwin Pai, MD, FRCS (Plast), is a plastic, reconstructive, and aesthetic surgeon, Wexham Park Hospital, Slough, United Kingdom
- Brecht Ceuterick, RN, is a perioperative nurse, Universitair Ziekenhuis, Brussels, Belgium
- Ayush Kapila, MD, MRCS, is a plastic surgery resident at the University of Brussels (VUB), Brussels, Belgium
| | - Ayush Kapila
- Maxim Geeroms, MD, PhD, is a plastic, reconstructive, and aesthetic surgeon in private practice, Brussels, Belgium
- Ashwin Pai, MD, FRCS (Plast), is a plastic, reconstructive, and aesthetic surgeon, Wexham Park Hospital, Slough, United Kingdom
- Brecht Ceuterick, RN, is a perioperative nurse, Universitair Ziekenhuis, Brussels, Belgium
- Ayush Kapila, MD, MRCS, is a plastic surgery resident at the University of Brussels (VUB), Brussels, Belgium
| |
Collapse
|
4
|
Osborne SR, Cockburn T, Davis J. Exploring Risk, Antecedents and Human Costs of Living with a Retained Surgical Item: A Narrative Synthesis of Australian Case Law 1981-2018. J Multidiscip Healthc 2021; 14:2397-2413. [PMID: 34511923 PMCID: PMC8421039 DOI: 10.2147/jmdh.s316166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/13/2021] [Indexed: 12/19/2022] Open
Abstract
Objectives This study aimed to critically examine the circumstances contributing to, and the human costs arising from, the retention of surgical items through the lens of Australian case law. Design Setting and Participants We reviewed Australian cases from 1981 to 2018 to establish a pattern of antecedents and identify long-term patient impacts (human costs) of retained surgical items. We used a modified four-step process to conduct a systematic review of legal doctrine, combined with a narrative synthesis approach to bring the information together for understanding. We searched LexisNexis, AustLII, Coroner Court websites, Australian Health Practitioner Regulation Agency Tribunal Decisions and Panel Hearings, Civil and Administrative Tribunal summaries, and other online sources for publicly available civil cases, medical disciplinary cases, coronial cases, and criminal cases across all Australian jurisdictions. Results Ten cases met the inclusion criteria, including one coronial case, three civil appeal cases, and six civil first instance cases. Time from item retention to discovery ranged from 12 days to 20 years, with surgical sponges the most frequently retained item. Five case reports indicated possible deviations from standard protocols regarding counting procedures and record-keeping. In the four cases that reported on count status, the count was deemed correct at the end of surgery. Case reports also showed the human costs of retained surgical items, that is, the long-term impacts on patients associated with a retained surgical item. In eight of the nine civil cases, ongoing pain was the most frequently reported physical symptom; in three cases, patients suffered psychosocial symptoms requiring treatment. Conclusion While there was little uniformity in the items retained or how items came to be retained, we identified significant time delays between item retention and item discovery, coupled with long-lasting physical and psychosocial harms suffered by patients living with a retained surgical item. Current prevention strategies, including national standards-based professional practices, are not always effective in preventing retained surgical items. An internationally standardised taxonomy and reporting criteria, more consistent reporting, and open access to event and risk data could inform a more accurate global estimate of risk and incidence of this hospital-acquired complication.
Collapse
Affiliation(s)
- Sonya R Osborne
- School of Nursing and Midwifery, Faculty of Health, Engineering and Sciences, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Tina Cockburn
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Juliet Davis
- Griffith Criminology Institute, Griffith University, Mt Gravatt, Queensland, Australia
| |
Collapse
|
5
|
Kastiunig T, Sortino R, Vines LC, Benigno L. Intra-abdominal foreign body as unexpected discovery mimicking suspicious malignancy. J Surg Case Rep 2021; 2021:rjab248. [PMID: 34178304 PMCID: PMC8221816 DOI: 10.1093/jscr/rjab248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/18/2021] [Indexed: 11/14/2022] Open
Abstract
Although rare, postoperatively retained foreign bodies in the abdominal cavity still represent a serious issue for the surgical team as for the patients. Its clinical manifestation is often unspecific and the cases are therefore only irregularly registered. There are several known factors that increase the risk of retention of a foreign body, for example emergency surgeries, unplanned changes in procedure or a high body mass index. In this article, we would like to report the case of a male patient with a foreign body in the right lower quadrant after open appendectomy mimicking a tumor.
Collapse
Affiliation(s)
- Theresa Kastiunig
- Correspondence address: Kantonales Spital Grabs, 9472 Grabs, Switzerland. Tel: 0041-81-772-5324; E-mail:
| | - Rosita Sortino
- Kantonsspital Sankt Gallen, 9000 Sankt Gallen, Switzerland
| | | | - Luca Benigno
- Kantonsspital Sankt Gallen, 9000 Sankt Gallen, Switzerland
| |
Collapse
|
6
|
Dislodged Bonded Molar Tube into Wound during Orthognathic Surgery. Case Rep Dent 2018; 2018:6540945. [PMID: 29971169 PMCID: PMC6009024 DOI: 10.1155/2018/6540945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/28/2018] [Accepted: 04/15/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction Dislodgement of orthodontic appliance into operation wounds may occur while performing orthognathic surgery. Its occurrence is commonly associated with bonded upper molar tube. Case Report A 25-year-old gentleman presented with recurrent upper right vestibular abscess three months following a bimaxillary orthognathic surgery. A bonded molar orthodontic tube had dislodged into the wound during the operation. The clinical presentation initially mimics an odontogenic infection until our investigations revealed that it originated from the dislodged appliance. The abscess was drained, the wound site was explored, and the molar tube and neighbouring rigid fixation plates and screws were removed. The patient recovered well following the procedure. Conclusion Dislodged metal orthodontic appliance in oral wound acts as a foreign body that may exert allergic reactions, infection, or inflammation. Pre- and postoperative intraoral examination of fixed orthodontic appliances including its count should be recorded in orthognathic surgery protocol.
Collapse
|