If You Know Them, You Avoid Them: The Imperative Need to Improve the Narrative Regarding Perioperative Adverse Events

Eppler, Michael; Sayegh, Aref S.; Goldenberg, Mitchell; Sholklapper, Tamir; Hemal, Sij; Cacciamani, Giovanni

doi:10.3390/jcm11174978

Cited by 11 publications

(8 citation statements)

References 29 publications

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“…Currently, the majority of data reported on this topic is derived from small case series or case reports [ 11 , 16 , 17 , 24 , 29 ], and there are no universally applicable guidelines for assessing, reporting, and managing this daunting intraoperative injury [ 32 , 33 , 34 , 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

Superior Mesenteric Artery Injury during Robotic Radical Nephrectomy: Scenarios and Management Strategies

Sayegh

Medina

Riva

et al. 2023

JCM

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Injury to the superior mesenteric artery (SMA) is a rare, underreported, and potentially devastating complication. This study aims to propose a systematic workup to describe how to prevent and manage SMA injury in a standardized stepwise manner. Three different instances of intraoperative injury to the SMA are described in an accompanying video. All three occurred when the SMA was misidentified as the left renal artery during left robotic radical nephrectomy. In the first case, the SMA was mistakenly identified as the renal artery, but after further dissection, the real renal artery was identified and SMA injury was prevented. In the second case, the SMA was clipped and the real left renal artery was subsequently identified, requiring clip removal. In the third case, the SMA was clipped and completely transected, requiring prompt repair by vascular surgery with a successful outcome. This study aims to propose a systematic workup to describe how to prevent and manage SMA injury in a standardized stepwise manner. The proper anatomic recognition of the SMA may prevent its injury. Intraoperative SMA injury should be promptly identified and repaired to avoid its devastating consequences.

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Section: Discussionmentioning

confidence: 99%

Superior Mesenteric Artery Injury during Robotic Radical Nephrectomy: Scenarios and Management Strategies

Sayegh

Medina

Riva

et al. 2023

JCM

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“…Though iAEs have been associated with increased morbidity, mortality, and postoperative complication rates [ 1 2 ], they have been underreported due to heterogeneous criteria and a lack of widespread acceptance [ 3 4 ]. In contrast, postoperative complication reporting has largely increased over the last few decades as a result of standardization and uniformity [ 5 6 7 8 9 ], thereby contributing to improved patient safety due to enhanced data quality and accuracy [ 10 11 12 13 14 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…Given the link between intraoperative and postoperative adverse events [ 1 2 ], the incentive to better understand iAEs is critical, as they offer an innovative lens through which patient care can be advanced. Even though prior attempts have been made, the reporting of iAEs still lacks standardization, resulting in a hurdle for optimal usage [ 16 17 18 19 ].…”

Section: Introductionmentioning

confidence: 99%

“…To overcome this barrier, the Intraoperative Complication Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration is constructing the foundation and resources needed to streamline the adoption and implementation of a standardized definition to assess, collect, grade, and report all iAEs [ 20 21 22 ]. This model creates a simple yet organized approach for gathering patient safety data, which not only fosters accurate reporting [ 5 16 ], but also creates interstudy reliability and consistency.…”

Section: Introductionmentioning

confidence: 99%

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Recommendations for Intraoperative Adverse Events Data Collection in Clinical Studies and Study Protocols. An ICARUS Global Surgical Collaboration Study

Cacciamani

Eppler

Sayegh

et al. 2023

International Journal of Surgery Protocols

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Introduction: Intraoperative adverse events (iAEs) occur and have the potential to impact the postoperative course. However, iAEs are underreported and are not routinely collected in the contemporary surgical literature. There is no widely utilized system for the collection of essential aspects of iAEs, and there is no established database for the standardization and dissemination of this data that likely have implications for outcomes and patient safety. The Intraoperative Complication Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration initiated a global effort to address these shortcomings, and the establishment of an adverse event data collection system is an essential step. In this study, we present the core-set variables for collecting iAEs that were based on the globally validated ICARUS criteria for surgical/interventional and anesthesiologic intraoperative adverse event collection and reporting. Material and Methods: This article includes three tools to capture the essential aspects of iAEs. The core-set variables were developed from the globally validated ICARUS criteria for reporting iAEs (item 1). Next, the summary table was developed to guide researchers in summarizing the accumulated iAE data in item 1 (item 2). Finally, this article includes examples of the method and results sections to include in a manuscript reporting iAE data (item 3). Then, 5 scenarios demonstrating best practices for completing items 1–3 were presented both in prose and in a video produced by the ICARUS collaboration. Dissemination: This article provides the surgical community with the tools for collecting essential iAE data. The ICARUS collaboration has already published the 13 criteria for reporting surgical adverse events, but this article is unique and essential as it actually provides the tools for iAE collection. The study team plans to collect feedback for future directions of adverse event collection and reporting. Highlights This article represents a novel, fully-encompassing system for the data collection of intraoperative adverse events. The presented core-set variables for reporting intraoperative adverse events are not based solely on our opinion, but rather are synthesized from the globally validated ICARUS criteria for reporting intraoperative adverse events. Together, the included text, figures, and ICARUS collaboration-produced video should equip any surgeon, anesthesiologist, or nurse with the tools to properly collect intraoperative adverse event data. Future directions include translation of this article to allow for the widest possible adoption of this important collection system.

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“…3 The accurate and uniform assessment and grading of perioperative AE severity are essential to ensure the ability to compare surgical procedures and study outcomes, and the usage of common terminology could allow large-scale data synthesis to inform clinical decision-making. [4][5][6] A lack of a standardized perioperative AE grading system likely impairs our understanding of the impact these events have on perioperative morbidity. 3 Such a standardized assessment tool may also be relevant for early allocation to different postoperative treatment and follow-up strategies and for learning purposes such as defining procedure-related proficiency.…”

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confidence: 99%

Severity Grading Systems for Intraoperative Adverse Events. A Systematic Review of the Literature and Citation Analysis

et al. 2023

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Introduction:The accurate assessment and grading of adverse events (AE) is essential to ensure comparisons between surgical procedures and outcomes. The current lack of a standardized severity grading system may limit our understanding of the true morbidity attributed to AEs in surgery. The aim of this study is to review the prevalence in which intraoperative adverse event (iAE) severity grading systems are used in the literature, evaluate the strengths and limitations of these systems, and appraise their applicability in clinical studies. Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. PubMed, Web of Science, and Scopus were queried to yield all clinical studies reporting the proposal and/or the validation of iAE severity grading systems. Google Scholar, Web of Science, and Scopus were searched separately to identify the articles citing the systems to grade iAEs identified in the first search. Results: Our search yielded 2957 studies, with 7 studies considered for the qualitative synthesis. Five studies considered only surgical-/interventional iAEs, while 2 considered both surgical/interventional and anesthesiologic iAEs. Two included studies validated the iAE severity grading system prospectively. A total of 357 citations were retrieved, with an overall self/nonself-citation ratio of 0.17 (53/304). The majority of citing articles were clinical studies (44.1%). The average number of citations per year was 6.7 citations for each classification/severity system, with only 2.05 citations/year for clinical studies. Of the 158 clinical studies citing the severity grading systems, only 90 (56.9%) used them to grade the iAEs. The appraisal of applicability (mean%/median%) was below the 70% threshold in 3 domains: stakeholder involvement (46/47), clarity of presentation (65/67), and applicability (57/56). Conclusion: Seven severity grading systems for iAEs have been published in the last decade. Despite the importance of collecting and grading the iAEs, these systems are poorly adopted, with only a few studies per year using them. A uniform globally implemented severity grading system is needed to produce comparable data across studies and develop strategies to decrease iAEs, further improving patient safety.

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If You Know Them, You Avoid Them: The Imperative Need to Improve the Narrative Regarding Perioperative Adverse Events

Abstract: There are few things in life as exciting as growing up in the countryside [...]

Cited by 11 publications

References 29 publications

Superior Mesenteric Artery Injury during Robotic Radical Nephrectomy: Scenarios and Management Strategies

Superior Mesenteric Artery Injury during Robotic Radical Nephrectomy: Scenarios and Management Strategies

Recommendations for Intraoperative Adverse Events Data Collection in Clinical Studies and Study Protocols. An ICARUS Global Surgical Collaboration Study

Severity Grading Systems for Intraoperative Adverse Events. A Systematic Review of the Literature and Citation Analysis

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