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Risk factors in patient safety: minimally invasive surgery versus conventional surgery
Sharon P Rodrigues1, Aurystella M Wever, Jenny Dankelman
1Department of Gynecology, Leiden University Medical Center, P.O. Box 9600, 2300, RC, Leiden, The Netherlands. S.P.Rodrigues@lumc.nl
Background:
This study aimed to identify the frequency of events in the different patient safety risk domains during minimally invasive surgery (MIS) and conventional surgery (CS).
Methods:
A convenience sample of gynecologic MIS and CS was observed. Events were observed and categorized into one of the predefined patient safety risk domains.
Results:
A total of 53 procedures were observed: 26 CS and 27 MIS procedures. The general characteristics were comparable between the two groups. A large number of environmental events were observed, averaging one every 2.5 min. Technical events and events of an organizational nature occurred more often in MIS (P < 0.01) than in CS (P < 0.01). The relative risk for the occurrence of one or more technical events in MIS compared with CS was 1.7, and the risk for two or more technical events was 4.1. A time out according to protocol showed no relationship to the occurrence of the different types of patient safety-related events.
Conclusion:
The technological complexity inherent in MIS makes this type of surgery more prone to technology-related problems than CS, even in a specially designed minimally invasive surgical suite. A regular time-out procedure developed for CS lacks the attention necessary for the complex technology used in MIS and therefore is insufficient for MIS procedures briefing. Incorporating a specially designed technology checklist in a regular briefing protocol could be a solution to decrease the number of events in MIS.
Insights
Minimally invasive surgery (MIS) has more technical and organizational safety events than conventional surgery (CS). A specialized technology checklist, not a standard time-out, is needed to improve MIS patient safety.
Area of Science:
- Surgical Safety
- Medical Technology Assessment
Background:
- Patient safety during surgical procedures is critical.
- Minimally invasive surgery (MIS) and conventional surgery (CS) present different risk profiles.
- Understanding event frequencies in various risk domains is essential for improving surgical outcomes.
Purpose of the Study:
- To determine the frequency of patient safety events in different risk domains during MIS and CS.
- To compare the incidence of these events between MIS and CS.
Main Methods:
- Observational study of gynecologic MIS and CS procedures.
- Categorization of observed events into predefined patient safety risk domains.
- Statistical analysis of event frequencies and relative risks between MIS and CS groups.
Main Results:
- 53 procedures (26 CS, 27 MIS) were analyzed with comparable general characteristics.
- Environmental events were frequent (1 per 2.5 min).
- Technical and organizational events occurred significantly more in MIS than CS (P < 0.01), with relative risks of 1.7 and 4.1 for one or more technical events, respectively. Standard time-out procedures did not correlate with event occurrence.
Conclusions:
- The inherent technological complexity of MIS increases susceptibility to technology-related problems compared to CS.
- Standard time-out protocols are insufficient for the complex technology in MIS.
- Implementing a technology-specific checklist within briefing protocols may reduce MIS-related events.
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