The Effect of Technical Performance on Patient Outcomes in Surgery

Fecso, Andras B.; Szasz, Peter; Kerezov, Georgi; Grantcharov, Teodor P.

doi:10.1097/sla.0000000000001959

Cited by 95 publications

(60 citation statements)

References 63 publications

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“…A successful surgical outcome is the result of many individual, team and organizational factors. At the same time, there is emerging evidence emphasizing the importance of both technical and non‐technical performance. Reports have indicated that most errors in the operating theatre are technical in nature, and technical performance may affect patient outcomes more than the perioperative management.…”

Section: Introductionmentioning

confidence: 99%

Relationship between intraoperative non-technical performance and technical events in bariatric surgery

Fecso

Kuzulugil

Babaoglu

et al. 2018

British Journal of Surgery

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Section: Introductionmentioning

confidence: 99%

Relationship between intraoperative non-technical performance and technical events in bariatric surgery

Fecso

Kuzulugil

Babaoglu

et al. 2018

British Journal of Surgery

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“…Therein lies a dichotomy, where increasing reliance now exists on fellowship training to bridge the shortfall in experience that is largely caused by changes in postgraduate surgical training and the well documented global reduction in working and training hours [34][35][36][37][38][39][40] . Changing training from a time-based to a competency-based system does not overcome such working time restrictions 41,42 and therefore explains the subsequent shift in training philosophy to that of proficiency-based models [43][44][45] .…”

Section: Introductionmentioning

confidence: 99%

Prior Generic Arthroscopic Volume Correlates with Hip Arthroscopic Proficiency

Erturan

Alvand

Judge

et al. 2018

The Journal of Bone and Joint Surgery

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“…Possibly, the improved surgical conditions in the narrow space of retroperitoneal laparoscopic surgery during high-dose rocuronium NMB contribute to superior technical performance of the surgeon and less trauma to tissue. A recent review supports this hypothesis by concluding that superior technical performance positively affects patient outcome [ 29 ]. An important reason for readmission was an infectious complication of the urinary tract (complicated urinary tract infection including pyelonephritis and urosepsis).…”

Section: Discussionmentioning

confidence: 93%

Impact of high- versus low-dose neuromuscular blocking agent administration on unplanned 30-day readmission rates in retroperitoneal laparoscopic surgery

et al. 2018

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Recent data shows that a neuromuscular block (NMB) induced by administration of high doses of rocuronium improves surgical conditions in certain procedures. However, there are limited data on the effect such practices on postoperative outcomes. We performed a retrospective analysis to compare unplanned 30-day readmissions in patients that received high-dose versus low-dose rocuronium administration during general anesthesia for laparoscopic retroperitoneal surgery. This retrospective cohort study was performed in the Netherlands in an academic hospital where routine high-dose rocuronium NMB has been practiced since July 2015. Charts of patients receiving anesthesia between January 2014 and December 2016 were searched for surgical cases receiving high-dose rocuronium and matched with respect to procedure, age, sex and ASA classification to patients receiving low-dose rocuronium. The primary post-operative outcome was unplanned 30-day readmission rate. There were 130 patients in each cohort. Patients in the high- and low-dose rocuronium cohorts received 217 ± 49 versus 37 ± 5 mg rocuronium, respectively. In the high-dose rocuronium group neuromuscular activity was consistently monitored; matched patients were unreliably monitored. All patients receiving high-dose rocuronium were reversed with sugammadex, while just 33% of matched patients were reversed with sugammadex and 20% with neostigmine; the remaining patients were not reversed. Unplanned 30-day readmission rate was significantly lower in the high-dose compared to the low-dose rocuronium cohort (3.8% vs. 12.7%; p = 0.03; odds ratio = 0.33, 95% C.I. 0.12–0.95). This small retrospective study demonstrates a lower incidence of unplanned readmissions within 30-days following laparoscopic retroperitoneal surgery with high-dose relaxant anesthesia and sugammadex reversal in comparison to low-dose relaxant anesthesia. Further prospective studies are needed in larger samples to corroborate our findings and additionally assess the pharmacoeconomics of high-dose relaxant anesthesia taking into account the benefits (reduced readmissions) and harm (cost of relaxants and reversal agents) of such practice.

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The Effect of Technical Performance on Patient Outcomes in Surgery

Cited by 95 publications

References 63 publications

Relationship between intraoperative non-technical performance and technical events in bariatric surgery

Relationship between intraoperative non-technical performance and technical events in bariatric surgery

Prior Generic Arthroscopic Volume Correlates with Hip Arthroscopic Proficiency

Impact of high- versus low-dose neuromuscular blocking agent administration on unplanned 30-day readmission rates in retroperitoneal laparoscopic surgery

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