Alexandroni H, Bahar R, Chill HH, Karavani G, Ben-Yossef O, Shushan A. Reducing Fluid-Related Complications During Operative Hysteroscopy: Use of a New Mandatory Fluid-Balance Form.
J Minim Invasive Gynecol 2017. [PMID:
28648840 DOI:
10.1016/j.jmig.2017.06.014]
[Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE
To examine whether our new reporting system and mandatory fluid-balance form could improve the communication and awareness within the surgical team and therefore the safety of hysteroscopic operations.
DESIGN
A case-control study (Canadian Task Force classification II-2).
SETTING
An endoscopic gynecology unit at a tertiary-care university hospital.
PATIENTS
Women aged 17 to 88 years (median, 43.9) who underwent operative hysteroscopy to treat uterine pathology.
INTERVENTIONS
Operative hysteroscopy was performed using bipolar technology and normal saline as an irrigation media with the new fluid-balance form and a mandatory reporting system. The control group was composed of women who underwent the procedure using the same technology, with a previous protocol.
MEASUREMENTS AND MAIN RESULTS
Data regarding intraoperative and postoperative short-term complications were prospectively collected during surgery and at the 2-week follow-up visit. About 2000 procedures were investigated (601 in the study group and 1396 in the control group). In the control group there were 20 incidents of fluid deficit over 2 L. In 4 of these cases the procedure was terminated, but in the other 16 cases the procedure was continued, with or without awareness of the surgeons to the deficit. Of these cases, 2 suffered from media-related complications, and in 3 others complications were avoided by diuretics. In contrast, in the study group there were 10 incidents of fluid deficit over 2 L, of which 5 cases were terminated on time and the other 5 continued under the informed decision of the surgeon. In this group, none of the women experienced a media-related complication. The difference between the number of procedures that were terminated on time between the control and study groups was not statistically significant (p = .115). There was a statistically significant reduction in the total complication rate between the study group (1.8%) and the control group (3.9%; p = .019).
CONCLUSIONS
The fluid-balance form and mandatory reporting system have been shown to reduce the rate of total complications in hysteroscopic surgeries, in particular media-related complications. This result is achieved by an improvement of the awareness and communication among the operating team, leading to an improvement in procedure safety.
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