Ensuring Surgical Safety: Initial Footstep in a Thousand Mile Journey An Initial outcome Study from a Developing Country

Background: Surgical adverse events due to negligence are increasingly recognized as an important aspect for preventing morbidity and mortality in healthcare system. WHO Safe Surgical Checklist provides an opportunity for surgical teams to minimize surgical adverse events by following just a simple checklist. The aim of this study is to assess the compliance of different members of the surgical team to this checklist and post operative outcomes before and after an orientation programme regarding the checklist. Methods: We observed 100 elective surgeries in the Department of Surgery of our institution and collected the baseline data regarding the use of WHO Safe Surgical Checklist in these surgeries. Following the collection of baseline data we organised an orientation program for the surgical team at our institution and collected the same data after orientation. Data obtained both before and after the data collection were compared. Results: This study has shown significant improvement in certain sections of the WHO Safe Surgical Checklist such as conformation, by the patient himself, of his identity (10%) , site of surgery (23%) and procedure to be performed (35%) . A significant increase has also been shown in estimation of the duration of surgery by the surgeons (11%) and specimen labelling (44%). The members of the surgical team introduced themselves more number of times (17%) after the orientation. Number of deaths (50%) and surgical site infections (80% class1 SSI, 25 % class 2 SSI, 13% class 3 SSI, 52% class 4 SSI) has also been shown to decrease following the checklist implementation. Conclusion: Implementation of this WHO Safe Surgical Checklist is beneficial both to the patient and to the surgical team and is not very difficult to comply with, considering the excellent post operative outcomes shown in this study. Compliance with all items on the checklist with active co-operation, co-ordination and participation by all team members are key factors that led to the successful implementation of the checklist

Evaluation of Clinical Outcome of Patients Undergoing Emergency Laparotomy with the Help of Portsmouth Predictor Equation for Mortality (P-Possum Score)

Introduction: Emergency laparotomy, though lifesaving, mayresult in significant morbidity and mortality. In an attempt toclinically evaluate patients undergoing emergency laparotomyand predict their mortality using the worldwide acceptedPortsmouth Predictor equation for mortality (P POSSUM), thepresent study was undertaken in the Surgery department of atertiary care hospital in eastern India.Material and methods: This observational cross-sectionalstudy included 60 patients aged between 15 to 75 years,undergoing emergency laparotomy during the specified studyperiod of one and half years.Results: It was observed that out of 60 patients, 63.3%were male, and mean age was 40.60 (16.67) years. Pepticperforation was the most common indication for laparotomy.Mean P POSSUM predicted mortality risk was 40.617%(Range-0.8 to 99.7). Twenty-four patients died during hospitalstay. ROC curve analysis of P POSSUM scores revealed thatif a cut off value of P POSSUM score of 42.45% was selected,mortality could be predicted with a sensitivity of 70.80% anda specificity of 83.30%.Conclusion: Thus, P POSSUM might be a useful tool inpredicting risk of short-term mortality following emergencylaparotomy

A study to evaluate the outcome following Anderson Hynes pyeloplasty in hydronephrosis patients with cummings stent and D-J stent

Background: Uretero-Pelvic Junction Obstruction (UPJO) is an important cause of hydronephrosis in pediatric age group. The choice of treatment could be conservative or surgical. Commonly Anderson-Hynes pyeloplasty is practiced with internal, external or partly internal partly external stent.Methods: This was a prospective study of 40 patients with UPJO, divided into 2 groups consecutively, each consisting of 20 patients. All patients underwent open Anderson-Hynes pyeloplasty. Cummings stent were given in one group for drainage and conventional DJ stent were used for another group.Results: The mean hospital stay was lesser in DJ stent group (8.4±2.13) compared to Cummings stent group (11.4±0.68), not only in respect to primary admission, but also including readmission for cystoscopic stent removal. The incidence of complications was also fewer in Cumming stent group. Stent migration and urinary tract infection (UTI) were more associated with DJ stent (2 each) than Cumming stent (0 each). However, dysuria was more in case of cumming stent (2 patients) than DJ stent (1 patient).Conclusions: The mean hospital stay in DJ stent insertion is less even if duration for cystoscopic removal is considered. The complication of stent removal and UTI are more with DJ stent though dysuria is more in case of Cummings stent.