High-resolution standardization reduces delay due to workflow disruptions in laparoscopic cholecystectomy

Torney, Marco von Strauss und; Aghlmandi, Sohelia; Zeindler, Jasmin; Nowakowski, Debora; Nebiker, Christian A.; Kettelhack, Christoph; Rosenthal, Rachel; Droeser, Raoul A.; Soysal, Savas D.; Hoffmann, Henry; Mechera, Robert

doi:10.1007/s00464-018-6224-y

Cited by 9 publications

(6 citation statements)

References 35 publications

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“…Laparoscopic cholecystectomy is known as one of the most common laparoscopic surgeries worldwide. [ 1 – 3 ] Carbon dioxide (CO 2 ) is used for pneumoperitoneum, which may result in the adverse cardiovascular effects. [ 4 – 6 ] They mainly include an abrupt elevation of mean arterial pressure, systemic vascular resistance, and decreased cardiac output because of the release of both catecholamines and vasopressin.…”

Section: Introductionmentioning

confidence: 99%

Influence of magnesium sulfate on hemodynamic responses during laparoscopic cholecystectomy

Zhang

Wang²,

Xu³

et al. 2018

Medicine

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Background:The impact of magnesium sulfate on hemodynamic responses during laparoscopic cholecystectomy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of magnesium sulfate on hemodynamic responses for laparoscopic cholecystectomy.Methods:We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through June 2018 for randomized controlled trials (RCTs) assessing the effect of magnesium sulfate on hemodynamic responses for laparoscopic cholecystectomy. Meta-analysis is performed using the random-effect model.Results:Four RCTs involving 208 patients are included in the meta-analysis. Overall, compared with control group in laparoscopic cholecystectomy, intravenous magnesium sulfate is associated with systolic blood pressure at 30 minutes [Std. MD = −1.34; 95% confidence interval (95% CI) = −1.86 to −0.82; P < .00001], diastolic blood pressure at 30 minutes (Std. MD = −1.40; 95% CI = −1.86 to −0.94; P < .00001), mean arterial pressure at 30 minutes (Std. MD = −1.19; 95% CI = −1.91 to −0.46; P = .001), systolic blood pressure at 10 minutes (Std. MD = −1.61; 95% CI = −2.08 to −1.13; P < .00001), diastolic blood pressure at 10 minutes (Std. MD = −1.54; 95% CI = −2.68 to −0.40; P = .008), heart rate at 30 minutes (Std. MD = −2.09; 95% CI = −2.87 to −1.32; P < .00001), but results in prolonged extubation time (Std. MD = 0.96; 95% CI = 0.18–1.74; P = .02).Conclusion:Magnesium sulfate can reduce blood pressure, but with the increase in extubation time for laparoscopic cholecystectomy.

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Section: Introductionmentioning

confidence: 99%

Influence of magnesium sulfate on hemodynamic responses during laparoscopic cholecystectomy

Zhang

Wang²,

Xu³

et al. 2018

Medicine

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“…Condensing these individual influences into a specific plan may be difficult and a surgeon reluctant to do so. Von Strauss has shown that creation of a standardized protocol for an operation can improve process quality [3]. Communication facilitation via the protocol surely plays an important role in process improvement.…”

Section: Discussionmentioning

confidence: 99%

“…Perioperative processes and their impact on overall quality of surgery are of growing importance in surgical research. In recent years, knowledge of the effects of optimizing medical processes in surgery has developed [1][2][3]. Mainly the focus was on patient safety and prevention of medical errors rather than on improving overall effectiveness and quality.…”

Section: Introductionmentioning

confidence: 99%

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Interprofessional differences in preoperative planning—the individualist surgeon

Haak¹,

Poletti

Grossman

et al. 2022

Eur Surg

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Summary Background Perioperative processes have a great impact on the quality of surgery. In a high-risk surrounding, proper planning and communication is of upmost importance. We have identified other professions next to surgery with comparable circumstances and conducted a survey to elaborate on the impact of perioperative processes. Objective To identify standards in preoperative planning in high-risk professions and determine possible shortcomings in surgical practice. Methods Two surveys were constructed and distributed to surgeons, mountain guides, and soldiers. Questions were designed to investigate preoperative planning behavior and compare the different professions. Results Nearly every participant (97%) agreed to the fact that preoperative planning helps to avoid complications. Most surgeons agreed that the preoperative and postoperative phase of care had the greatest ability to improve overall quality of care. The opinions about planning were divided. The minority of surgeons agreed to the importance of sharing a plan preoperatively. Soldiers were the profession with the highest rate of plan sharing. Conclusion The readiness to communicate varies between professions and is lowest for surgeons. Missing standardization of procedures and the surgeon’s ego might be explanations for this behavior. Interventions to overcome this shortcoming, like the preoperative team timeout, have already been implemented but further improvements are needed.

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“…14 15 This considerable prolongation of the operating time results in substantially increased costs. 16 As current research suggests that different types of FDs may have specific effects-some are harmful, others beneficial and some essential for a seamless surgical workflowdetailed classification and systematic aggregation is essential. 11 Despite the growing interest and literature on surgical FDs, there is, to the best of our knowledge, no systematic review that synthesises the current research base and considers the diversity of potential effects.…”

Section: Introductionmentioning

confidence: 99%

Associations of workflow disruptions in the operating room with surgical outcomes: a systematic review and narrative synthesis

Koch¹,

Burns

Catchpole

et al. 2020

BMJ Qual Saf

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BackgroundPerformance in the operating room is an important determinant of surgical safety. Flow disruptions (FDs) represent system-related performance problems that affect the efficiency of the surgical team and have been associated with a risk to patient safety. Despite the growing evidence base on FDs, a systematic synthesis has not yet been published.ObjectiveOur aim was to identify, evaluate and summarise the evidence on relationships between intraoperative FD events and provider, surgical process and patient outcomes.MethodsWe systematically searched databases MEDLINE, Embase and PsycINFO (last update: September 2019). Two reviewers independently screened the resulting studies at the title/abstract and full text stage in duplicate, and all inconsistencies were resolved through discussion. We assessed the risk of bias of included studies using established and validated tools. We summarised effects from included studies through a narrative synthesis, stratified based on predefined surgical outcome categories, including surgical process, provider and patient outcomes.ResultsWe screened a total of 20 481 studies. 38 studies were found to be eligible. Included studies were highly heterogeneous in terms of methodology, medical specialty and context. Across studies, 20.5% of operating time was attributed to FDs. Various other process, patient and provider outcomes were reported. Most studies reported negative or non-significant associations of FDs with surgical outcomes.ConclusionApart from the identified relationship of FDs with procedure duration, the evidence base concerning the impact of FDs on provider, surgical process and patient outcomes is limited and heterogeneous. We further provide recommendations concerning use of methods, relevant outcomes and avenues for future research on associated effects of FDs in surgery.

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High-resolution standardization reduces delay due to workflow disruptions in laparoscopic cholecystectomy

Abstract: HRSL is effective in reducing delays due to MC in a teaching institution with limited team experience. These findings should be tested in larger potentially cluster-randomized controlled trials. The trial has been registered with clinicaltrials.gov: NCT03329859.

Cited by 9 publications

References 35 publications

Influence of magnesium sulfate on hemodynamic responses during laparoscopic cholecystectomy

Influence of magnesium sulfate on hemodynamic responses during laparoscopic cholecystectomy

Interprofessional differences in preoperative planning—the individualist surgeon

Associations of workflow disruptions in the operating room with surgical outcomes: a systematic review and narrative synthesis

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