N K Francis1,2, N J Curtis3,4, J A Conti5,6, J D Foster3,4, H J Bonjer7, G B Hanna4. 1. Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, BA21 4AT, UK. nader.francis@ydh.nhs.uk. 2. Faculty of Science, University of Bath, Wessex House 3.22, Bath, BA2 7AY, UK. nader.francis@ydh.nhs.uk. 3. Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, BA21 4AT, UK. 4. Department of Surgery and Cancer, Imperial College London, Level 10, St Mary's Hospital, Praed Street, London, W2 1NY, UK. 5. Department of Colorectal Surgery, Queen Alexandra Hospital, Cosham, Portsmouth, PO6 3LY, UK. 6. Academic Surgical Unit, University of Southampton, Level C, Southampton General Hospital, Southampton, SO16 6YD, UK. 7. Department of Surgery, VU University Medical Centre, 1081 HV, Amsterdam, The Netherlands.
Abstract
BACKGROUND: Surgical outcomes are traditionally evaluated by post-operative data such as histopathology and morbidity. Although these outcomes are reported using accepted systems, their ability to influence operative performance is limited by their retrospective application. Interest in direct measurement of intraoperative events is growing but no available systems applicable to routine practice exist. We aimed to develop a structured, practical method to report intraoperative adverse events enacted during minimal access surgical procedures. METHODS: A structured mixed methodology approach was adopted. Current intraoperative adverse event reporting practices and desirable system characteristics were sought through a survey of the EAES executive. The observational clinical human reliability analysis method was applied to a series of laparoscopic total mesorectal excision (TME) case videos to identify intraoperative adverse events. In keeping with survey results, observed events were further categorised into non-consequential and consequential, which were further subdivided into four levels based upon the principle of therapy required to correct the event. A second survey phase explored usability, acceptability, face and content validity of the novel classification. RESULTS: 217 h of TME surgery were analysed to develop and continually refine the five-point hierarchical structure. 34 EAES expert surgeons (69%) responded. The lack of an accepted system was the main barrier to routine reporting. Simplicity, reproducibility and clinical utility were identified as essential requirements. The observed distribution of intraoperative adverse events was 60.1% grade I (non-consequential), 37.1% grade II (minor corrective action), 2.4% grade III (major correction or change in post-operative care) and 0.1% grade IV (life threatening). 84% agreed with the proposed classification (Likert scale 4.04) and 92% felt it was applicable to their practice and incorporated all desirable characteristics. CONCLUSION: A clinically applicable intraoperative adverse event classification, which is acceptable to expert surgeons, is reported and complements the objective assessment of minimal access surgical performance.
BACKGROUND: Surgical outcomes are traditionally evaluated by post-operative data such as histopathology and morbidity. Although these outcomes are reported using accepted systems, their ability to influence operative performance is limited by their retrospective application. Interest in direct measurement of intraoperative events is growing but no available systems applicable to routine practice exist. We aimed to develop a structured, practical method to report intraoperative adverse events enacted during minimal access surgical procedures. METHODS: A structured mixed methodology approach was adopted. Current intraoperative adverse event reporting practices and desirable system characteristics were sought through a survey of the EAES executive. The observational clinical human reliability analysis method was applied to a series of laparoscopic total mesorectal excision (TME) case videos to identify intraoperative adverse events. In keeping with survey results, observed events were further categorised into non-consequential and consequential, which were further subdivided into four levels based upon the principle of therapy required to correct the event. A second survey phase explored usability, acceptability, face and content validity of the novel classification. RESULTS: 217 h of TME surgery were analysed to develop and continually refine the five-point hierarchical structure. 34 EAES expert surgeons (69%) responded. The lack of an accepted system was the main barrier to routine reporting. Simplicity, reproducibility and clinical utility were identified as essential requirements. The observed distribution of intraoperative adverse events was 60.1% grade I (non-consequential), 37.1% grade II (minor corrective action), 2.4% grade III (major correction or change in post-operative care) and 0.1% grade IV (life threatening). 84% agreed with the proposed classification (Likert scale 4.04) and 92% felt it was applicable to their practice and incorporated all desirable characteristics. CONCLUSION: A clinically applicable intraoperative adverse event classification, which is acceptable to expert surgeons, is reported and complements the objective assessment of minimal access surgical performance.
Authors: Sheraz R Markar; Tom Wiggins; Melody Ni; Ewout W Steyerberg; J Jan B Van Lanschot; Mitsuru Sasako; George B Hanna Journal: Lancet Oncol Date: 2014-12-29 Impact factor: 41.316
Authors: Aaron S Rickles; David W Dietz; George J Chang; Steven D Wexner; Mariana E Berho; Feza H Remzi; Frederick L Greene; James W Fleshman; Maher A Abbas; Walter Peters; Katia Noyes; John R T Monson; Fergal J Fleming Journal: Ann Surg Date: 2015-12 Impact factor: 12.969
Authors: Hans F Fuchs; Ryan C Broderick; Cristina R Harnsberger; David C Chang; Elisabeth C Mclemore; Sonia Ramamoorthy; Santiago Horgan Journal: Surg Endosc Date: 2014-12-25 Impact factor: 4.584
Authors: J D Foster; P Ewings; S Falk; E J Cooper; H Roach; N P West; B A Williams-Yesson; G B Hanna; N K Francis Journal: Tech Coloproctol Date: 2016-08-10 Impact factor: 3.781
Authors: J D Foster; D Miskovic; A S Allison; J A Conti; J Ockrim; E J Cooper; G B Hanna; N K Francis Journal: Tech Coloproctol Date: 2016-05-06 Impact factor: 3.781
Authors: Lukasz Filip Grochola; Christopher Soll; Adrian Zehnder; Roland Wyss; Pascal Herzog; Stefan Breitenstein Journal: Surg Endosc Date: 2018-09-14 Impact factor: 4.584
Authors: Martin Wagner; Johanna M Brandenburg; Sebastian Bodenstedt; André Schulze; Alexander C Jenke; Antonia Stern; Marie T J Daum; Lars Mündermann; Fiona R Kolbinger; Nithya Bhasker; Gerd Schneider; Grit Krause-Jüttler; Hisham Alwanni; Fleur Fritz-Kebede; Oliver Burgert; Dirk Wilhelm; Johannes Fallert; Felix Nickel; Lena Maier-Hein; Martin Dugas; Marius Distler; Jürgen Weitz; Beat-Peter Müller-Stich; Stefanie Speidel Journal: Surg Endosc Date: 2022-09-28 Impact factor: 3.453
Authors: Salome Dell-Kuster; Nuno V Gomes; Larsa Gawria; Soheila Aghlmandi; Maame Aduse-Poku; Ian Bissett; Catherine Blanc; Christian Brandt; Richard B Ten Broek; Heinz R Bruppacher; Cillian Clancy; Paolo Delrio; Eloy Espin; Konstantinos Galanos-Demiris; I Ethem Gecim; Shahbaz Ghaffari; Olivier Gié; Barbara Goebel; Dieter Hahnloser; Friedrich Herbst; Ioannidis Orestis; Sonja Joller; Soojin Kang; Rocio Martín; Johannes Mayr; Sonja Meier; Jothi Murugesan; Deirdre Nally; Menekse Ozcelik; Ugo Pace; Michael Passeri; Simone Rabanser; Barbara Ranter; Daniela Rega; Paul F Ridgway; Camiel Rosman; Roger Schmid; Philippe Schumacher; Alejandro Solis-Pena; Laura Villarino; Dionisios Vrochides; Alexander Engel; Greg O'Grady; Benjamin Loveday; Luzius A Steiner; Harry Van Goor; Heiner C Bucher; Pierre-Alain Clavien; Philipp Kirchhoff; Rachel Rosenthal Journal: BMJ Date: 2020-08-25
Authors: Michael Eppler; Aref S Sayegh; Mitchell Goldenberg; Tamir Sholklapper; Sij Hemal; Giovanni E Cacciamani Journal: J Clin Med Date: 2022-08-25 Impact factor: 4.964