Working Definitions of “Critical Portions”

Abstract

Objective: Identify the considerations academic surgeons use when determining which portions of a procedure are "critical" and necessitate their presence. Background: Teaching physicians are required to be present for the "critical portion" of surgical procedures, but the definition of what constitutes a critical portion remains elusive. Current guidelines defer to surgeons' expert judgment in identifying critical portion(s) of a procedure; little is known about what concepts surgeons apply when deciding what parts of a procedure are critical. Methods: Qualitative analysis of interviews with 51 practicing surgeons from a range of specialties regarding their working definition of critical portions. Results: Surgeons identified 4 common themes that they use in practice to define the critical portions of procedures: portions that require their firsthand observation of events, those involving challenging anatomy or structures that cannot be repaired if injured, and portions where an error would result in severe consequences for the patient. Surgeons also recognized contextual factors regarding the patient, trainee, surgeon, and team that might alter determinations for individual cases. Conclusions: Although critical portion definitions are largely treated as subjective, surgeons across multiple specialties identified consistent themes defining "critical portions'', suggesting that setting a minimum standard for criticality is feasible for specific procedures. Surgeons also recognized contextual factors that support the need for case-specific judgement beyond minimum standard. This framework of procedure features and contextual factors may be used as a guide for surgeons making day-to-day decisions and in future work to formally define critical portions for a given procedure.

Privacy-preserving Algorithms Can Facilitate Surgical Video Databases for Quality Improvement, Education, and Research

“…Work of De Backer and colleagues helps tackle privacy concerns in such data. We must now also consider how best to advocate for cultural, legal, and regulatory changes that will allow surgeons and researchers to fully understand the intraoperative phase of care through the systematic and scientific collection, storage, and analysis of surgical video 12 …”

Defining Critical Portions of Surgery

“…Strict rules often result in unintended consequences. In this issue of Annals of Surgery , Langerman et al4 venture to define critical portions of surgical procedures through thematic analyses of in-depth interviews with academic attending otolaryngologists, neurosurgeons, and general surgeons. Using themes that emerged from these interviews, the authors propose a framework of procedural features and contextual factors that can be used to guide surgeons in decision-making and when considering further efforts to formally define critical portions of surgical cases.…”

“…Case-specific considerations are broad, and variability exists not only among specialties but also within a single surgical discipline. For example, some have suggested that all portions of a surgical procedure are considered critical except for opening and closing 4. However, this blanket definition cannot be applied for many reconstructive procedures where opening and closing comprise the case itself.…”

“…For example, some have suggested that all portions of a surgical procedure are considered critical except for opening and closing. 4 However, this blanket definition cannot be applied for many reconstructive procedures where opening and closing comprise the case itself.…”