Assessment of postoperative morbidity in Spanish hospitals: Results from a national survey.

BACKGROUND: The methodology used for recording, evaluating and reporting postoperative complications (PC) is unknown. The aim of the present study was to determine how PC are recorded, evaluated, and reported in General and Digestive Surgery Services (GDSS) in Spain, and to assess their stance on morbidity audits. METHODS: Using a cross-sectional study design, an anonymous survey of 50 questions was sent to all the heads of GDSS at hospitals in Spain. RESULTS: The survey was answered by 67 out of 222 services (30.2%). These services have a reference population (RP) of 15 715 174 inhabitants, representing 33% of the Spanish population. Only 15 services reported being requested to supply data on morbidity by their hospital administrators. Eighteen GDSS, with a RP of 3 241 000 (20.6%) did not record PC. Among these, 7 were accredited for some area of training. Thirty-six GDSS (RP 8 753 174 (55.7%) did not provide details on all PC in patients' discharge reports. Twenty-four (37%) of the 65 GDSS that had started using a new surgical procedure/technique had not recorded PC in any way. Sixty-five GDSS were not concerned by the prospect of their results being audited, and 65 thought that a more comprehensive knowledge of PC would help them improve their results. Out of the 37 GDSS that reported publishing their results, 27 had consulted only one source of information: medical progress records in 11 cases, and discharge reports in 9. CONCLUSIONS: This study reflects serious deficiencies in the recording, evaluation and reporting of PC by GDSS in Spain.

Surgical waiting lists and queue management in a Brazilian tertiary public hospital.

BACKGROUND: Centralized management of queues helps to reduce the surgical waiting time in the publicly funded healthcare system, but this is not a reality in the Brazilian Unified Healthcare System (BUHS). We describe the implementation of the "Patients with Surgical Indication" (PSI) in a Brazilian public tertiary hospital, the impact on waiting time, and its use in rationing oncological surgeries during the COVID-19 Pandemic. METHODS: Retrospective observational study of elective surgical requests (2016-2022) in a Brazilian general, public, tertiary university hospital. We recovered information regarding the inflows (indications), outflows and their reasons, the number of patients, and waiting time in queue. RESULTS: We enrolled 82,844 indications in the PSI (2016-2022). The waiting time (median and interquartile range) in days decreased from 98(48;168) in 2016 to 14(3;152) in 2022 (p < 0.01). The same occurred with the backlog that ranged from 6,884 in 2016 to 844 in 2022 (p < 001). During the Pandemic, there was a reduction in the number of non-oncological surgeries per month (95% confidence interval) of -10.9(-18.0;-3.8) during Phase I (January 2019-March 2020), maintenance in Phase II (April 2020-August 2021) 0.1(-10.0;10.4) and increment in Phase III (September 2021-December 2022) of 23.0(15.3;30.8). In the oncological conditions, these numbers were 0.6(-2.1;3.3) for Phase I, an increase of 3.2(0.7;5.6) in Phase II and 3.9(1,4;6,4) in Phase III. CONCLUSION: Implementing a centralized list of surgical indications and developing queue management principles proved feasible, with effective rationing. It unprecedentedly demonstrated the decrease in the median waiting time in Brazil.

Effectiveness of continuity of care after robot-assisted laparoscopic adrenalectomy under ambulatory mode: a single-center intervention study.

To investigate the effectiveness of continuity of care after robot-assisted adrenal tumor resection under ambulatory mode. Patients who underwent robot-assisted laparoscopic adrenalectomy (RALA) in the ambulatory surgery department and urology department of our hospital from January 2022 to January 2023 were selected as study subjects. Among them, 50 patients in the Department of Urology as the control group were given routine care. The 50 patients in the ambulatory surgery department as the observation group were given continuity of care on the basis of routine care. Observation indexes include: wound healing, blood pressure, blood potassium, renal function impairment, self-care ability in daily life, medication compliance, follow-up rate, and patient satisfaction. There were no remarkable discrepancies between the two groups in terms of demographic data and basic preoperative conditions of the patients. Compared with the control group, the observation group significantly improved the patients' wound healing, postoperative blood pressure and blood potassium and kidney function (P value all < 0.05). Compared with the control group, the observation group significantly improved postoperative patients' ADL scores, follow-up rates within three months after surgery, and patient satisfaction scores (P value all < 0.05). For patients receiving ambulatory mode robot-assisted laparoscopic adrenalectomy, continuity of care can effectively reduce postoperative complications, improve patients' postoperative self-care ability in daily life, medication compliance and follow-up rate, and improve patient satisfaction, which is worthy of promotion and application by nursing workers.

Ultrassonografia na prática assistencial do enfermeiro do bloco operatório: revisão de escopo / Ultrasound in the care practice of the nurse in the operating room: scope review

OBJETIVO: identificar na literatura científica aplicações para o uso da ultrassonografia por enfermeiros no bloco operatório. MÉTODO: revisão de escopo realizada de acordo com a metodologia proposta pelo Instituto Joanna Briggs para responder à pergunta norteadora: Quais os possíveis usos da ultrassonografia por enfermeiros do bloco operatório? Os artigos foram buscados nas principais bases internacionais de literatura científica e cinzenta. Os descritores utilizados serão ultrassonografia e centros cirúrgicos. A pesquisa se orientou pelo acrônimo P-C-C: P ­ Participantes: Equipe de Enfermagem do Centro Cirúrgico; C ­ Conceito: Ultrassonografia; C - Contexto: Centro Cirúrgico. Registro do protocolo: osf.io/p8zne. RESULTADOS: os estudos encontrados versavam sobre três usos principais da ultrassonografia para enfermeiros perioperatórios no cenário do bloco operatório: avaliação gástrica (N=7), avaliação de conteúdo vesical (N=10) e auxiliar para punção periférica venosa e arterial (N=3). CONCLUSÃO: os enfermeiros perioperatórios devem buscar formação para práticas avançadas incluindo o uso de ultrassonografia como auxiliar em sua prática.

OBJECTIVE: To identify applications for using ultrasonography by nurses in the operating room in the scientific literature. METHOD: Scope review carried out according to the methodology proposed by the Joanna Briggs Institute to answer the guiding question: What are the possible uses of ultrasound by nurses in the operating room? The articles were sought in the main international scientific and gray literature bases. The descriptors used will be ultrasonography and surgical centers. The research was guided by the acronym P-C-C: P ­ Participants: Surgical Center Nursing Team; C - Concept: Ultrasound; C - Context: Surgical Center. Protocol Registration: osf.io/p8zne. RESULTS: The studies found covered three main uses of ultrasound for perioperative nurses in the operating room scenario: gastric evaluation (N=7), evaluation of vesical content (N=10), and auxiliary for venous and arterial peripheral puncture (N=3). CONCLUSION: Perioperative nurses should seek training for advanced practices, including using ultrasound to aid in their practice.

Desarrollo de una Unidad de Cirugía Hepatobiliar Compleja y Trasplante Hepático en un hospital público: a una década de su formación / Development of a complex hepatobiliary surgery and liver transplantation unit in a public hospital: a decade after its creation

RESUMEN Antecedentes: concentrar esta patología hepatobiliar en centros especializados puede permitir bajas cifras de morbimortalidad y mejores resultados alejados. Objetivo: describir las características clínico-patológicas y los resultados de una serie de pacientes operados en los primeros 10 años de una Unidad de Cirugía Hepatobiliar Compleja y Trasplante Hepático (TH), así como la actividad científica y docente de sus integrantes. Materiales y métodos: estudio retrospectivo descriptivo. Se recopiló información de una base de datos prospectiva. Se clasificaron los procedimientos según su complejidad y se analizaron los TH, las hepatectomías y los procedimientos biliares complejos, realizados entre 2013 y 2022. Resultados: sobre 1440 procedimientos quirúrgicos, 832 fueron de alta complejidad (58%). Se realizaron 452 trasplantes hepáticos (TH), 14 (3%) de ellos hepatorrenales; la sobrevida global del trasplante fue de 83%, 77% y 75% a 1, 3 y 5 años, respectivamente. La falla primaria del injerto se observó en 5 casos (1,1%). Se efectuaron 254 hepatectomías: 58 (23%) por patología benigna, 155 (61%) por patología maligna y 41 (16%) en donante vivo relacionado para TH. La morbilidad total fue del 27% y la mortalidad intrahospitalaria de 2%. Se efectuaron 106 derivaciones biliodigestivas: 53 en pacientes con lesión quirúrgica de la vía biliar. La morbilidad a 30 días fue del 42%, en su mayoría complicaciones menores (28%). Además, se realizaron 17 duodenopancreatectomías cefálicas y 3 esplenopancreatectomías. Se realizaron múltiples publicaciones, presentaciones y cursos, y desde 2015 se implementó una residencia posbásica de la especialidad. Conclusión: la concentración de patología hepatobiliar en un centro de alta complejidad permitió alcanzar resultados satisfactorios, comparables con series extranjeras.

ABSTRACT Background: Centralizing hepatobiliary disease in specialized centers can reduce morbidity and mortality rates and improve long-term outcomes. Objective: The aim of the present study was to describe the clinical and pathological features and surgical outcomes of a series of patients operated on in the Hepatobiliary Surgery and Liver Transplantation Unit of Hospital El Cruce during its first 10 years, as well as the scientific and educational activity of its members. Material and methods: We conducted a descriptive and retrospective study. The information was retrieved from a prospective database. The procedures were classified according to their complexity. An analysis was conducted on liver transplantations (LTs), liver resections and complex biliary procedures, performed from 2013 to 2022. Results: Of 1449 surgical procedures, 832 were high-complexity interventions (58%). A total of 452 LTs were performed, 14 (3%) were combined liver and kidney transplantations; overall transplant survival was 83%, 77% and 75% at 1, 3 and 5 years, respectively. Primary graft dysfunction was observed in 5 cases (1.1%). There were 254 liver resections; 58 cases (23%) were related to benign liver diseases, 155 (61%) to malignancies, and 41 (16%) were associated with living donor transplants. Overall morbidity was 27% and in-hospital mortality was 2%. A total of 106 bilio-digestive bypass procedures were carried out, 53 in patients with bile duct injury. Thirty-day morbidity was 42%, and most cases were minor complications (28%). Other procedures included 17 cephalic pancreaticoduodenectomies and 3 splenectomies and distal pancreatectomies. We have published numerous papers, delivered presentations and courses, and implemented a fellowship program in the specialty since 2015. Conclusion: Centralizing hepatobiliary diseases at a high-complexity center led to comparable outcomes with those reported in international series.

Impact of the Five-Year Intervention of an Antimicrobial Stewardship Program on the Optimal Selection of Surgical Prophylaxis in a Hospital without Antibiotic Prescription Restrictions in Costa Rica: A Retrospective Study.

This study aims to characterize the impact of the implementation of an antimicrobial stewardship program (AMS) on the optimal selection of surgical antibiotic prophylaxis in adult patients. This is a retrospective quasi-experimental study that compared the selection and duration of antibiotics for all surgical prophylaxis prescriptions over six months, both before (pre-AMS) and after a five-year intervention of AMS (post-AMS). In addition, data related to the consumption of antibiotics, adverse drug reactions, and surgical site infections throughout the years of the intervention were analyzed. The rate of appropriate selection of antibiotic prophylaxis in surgical procedures improved to 80% during the post-AMS period. The percentage of optimal duration increased from 69.1% (N = 1598) in the pre-AMS period to 78.0% (N = 841) in the post-AMS period (p < 0.001). The consumption of ceftriaxone significantly decreased, while the use of cefazolin increased more than nine times. No severe adverse reactions or increases in surgical site infections were detected after the intervention. The implementation of an AMS in the surgical ward demonstrated a trend towards a positive overall impact on the selection and duration of prophylactic antibiotics for surgery, with positive results also observed in other variables associated with the prescription of these antibiotics.

Digital interprofessional communication with families in a cardiac surgery unit: insights from the pandemic.

Background: The COVID-19 pandemic entailed cutting off the usual access to hospitals, denying patients daily visits from their relatives and friends. The standard communication between medical staff and relatives also suffered, with a perceived negative impact on overall care. We developed an electronic communication solution to re-establish a proactive daily communication with patients' families. Methods: The communication software allowed families to receive daily interprofessional (medical, nursing, and physiotherapy) updates by text message, on patients' postoperative clinical state. Appreciation and performance of this communication was evaluated through a prospective randomised study. Two groups were compared (group D, 32 patients "Digital" receiving daily SMS, and group S, 16 patients "Standard" without SMS), assessing satisfaction through dedicated surveys under COVID-19 restrictions. Moreover, private outgoing vs. incoming communication flow between patients and their relatives (phone calls and text messages, for both groups) were analysed at different timeframes of the postoperative hospital stay. Results: Mean age of the population was 66 ± 7 years for both groups. The digital communication service was successfully adopted in group D in all cases, sending overall 155 communications (4.84 per patient). Calls received from relatives were 13 in group D vs. 22 in group S (0.4 vs. 1.4 calls per patient, p = 0.002). Patients' outgoing vs. incoming traffic flow was equal in the two groups for every timeframe (first two postoperative days vs. the rest), independently from digital communication. Comparing satisfaction of communication (from 1 to 7), level of information and understandability resulted in 6.7 in group D vs. 5.6 in group S (p = 0.004). Appreciation of digital communication was highest during the first three postoperative days. Conclusion: The restrictions caused by the COVID-19 pandemic generated simple and effective ideas on digital solutions for interprofessional communication. Offering this digital service, which complements rather than replace the classic communication, eased the need of the families to be informed and significantly enhanced the overall satisfaction regarding the healthcare service. Summary: The COVID-19 pandemic has interrupted access to hospital patients and cut off physical contact, denying patients, their families, and medical staff the necessary constant communication about the progress of their stay. It has become necessary, therefore, to compensate for the lack of "physical" face-to-face interaction by introducing innovative digital communication solutions. Our interprofessional project aims to assess the overall satisfaction and acceptance of digital communication service between the hospital and the families, updating on postoperative clinical condition of patients. Specifically, the introduction of a digital communication module attached to the electronic patient record allows relatives to be informed on a daily basis. The development of this module/software enabled families to receive daily, interprofessional and proactive digital updates, on their relative ones' postoperative stay.

Factors contributing to preventing operating room "never events": a machine learning analysis.

BACKGROUND: A surgical "Never Event" is a preventable error occurring immediately before, during or immediately following surgery. Various factors contribute to the occurrence of major Never Events, but little is known about their quantified risk in relation to a surgery's characteristics. Our study uses machine learning to reveal and quantify risk factors with the goal of improving patient safety and quality of care. METHODS: We used data from 9,234 observations on safety standards and 101 root-cause analyses from actual, major "Never Events" including wrong site surgery and retained foreign item, and three random forest supervised machine learning models to identify risk factors. Using a standard 10-cross validation technique, we evaluated the models' metrics, measuring their impact on the occurrence of the two types of Never Events through Gini impurity. RESULTS: We identified 24 contributing factors in six surgical departments: two had an impact of > 900% in Urology, Orthopedics, and General Surgery; six had an impact of 0-900% in Gynecology, Urology, and Cardiology; and 17 had an impact of < 0%. Combining factors revealed 15-20 pairs with an increased probability in five departments: Gynecology, 875-1900%; Urology, 1900-2600%; Cardiology, 833-1500%; Orthopedics,1825-4225%; and General Surgery, 2720-13,600%. Five factors affected wrong site surgery's occurrence (-60.96 to 503.92%) and five affected retained foreign body (-74.65 to 151.43%): two nurses (66.26-87.92%), surgery length < 1 h (85.56-122.91%), and surgery length 1-2 h (-60.96 to 85.56%). CONCLUSIONS: Using machine learning, we could quantify the risk factors' potential impact on wrong site surgeries and retained foreign items in relation to a surgery's characteristics, suggesting that safety standards should be adjusted to surgery's characteristics based on risk assessment in each operating room. . TRIAL REGISTRATION NUMBER: MOH 032-2019.

Evaluation on the application effect of "flipped classroom" in general surgery practice teaching / 中华医学教育探索杂志

Objective:To explore the application and practice of "flipped classroom" in the teaching of general surgery interns.Methods:A total of 20 internship groups (3 to 5 people in each group) were randomly selected from the general surgery practice group in the Department of General Surgery of the Second Clinical Medical College of North Sichuan Medical College. They were randomly divided into the flipped group (45 people) and the traditional group (40 people), with 10 subgroups in each group. The flipped group adopted the flipped classroom teaching mode (students' self-study by handing out materials before class, students and teachers' discussion in class, and students and teachers' evaluation after class), while the control group adopted the current conventional teaching mode (students' preview before class, teachers' explanation in class, and teachers' question answering after class). At the end of the teaching, a questionnaire was used to evaluate the participation and completion of each student. The teaching effect was evaluated by medical history collection and case analysis. The participation, completion, and teaching effect between the two groups were compared and analyzed. SPSS 23.0 software was used for t-test and Chi-square test. Results:The participation of the flipped group was better than that of the traditional group [(17.45±1.83) vs. (15.57±1.52)], and the difference was statistically significant ( P < 0.05). There was no statistically significant difference between the flipped group and the traditional group. There was no significant difference in medical history collection scores between the two groups. The case analysis of the flipped group was better than that of the traditional group [(87.30±6.06) vs. (81.50±5.88), P < 0.05]. The questionnaire shows that about 90% of the students think that flipped classroom can improve their interest in learning [96% (43/45)], improve their autonomous learning ability [89% (40/45)], and have better learning effect. At the same time, 78% (35/45) of students think that learning time is too long. Conclusion:The flipped classroom teaching model can improve the teaching participation of general surgery students, improve students' interest in learning, improve their self-learning ability, and improve students' thinking ability of medical record analysis.

Impact of surgical checklists on the time of surgical processes: a cross-sectional study / Impacto de checklists cirúrgicos no tempo dos processos operatórios: um estudo transversal

ABSTRACT Objectives: to analyze the impact of the use of checklists on the mean time of the operative processes of patients undergoing hip and knee arthroplasties. Method: cross-sectional and analytical research conducted between November/2020 and March/2022 with retrospective consultation in a simple random sample of 291 medical records, distributed in three periods (2010/2013/2016). Descriptive and inferential statistics were used for data analysis; p=0.05 values indicated significance. Results: there was a reduction in the time of entry-exit from the operating room (p=0.002), surgery (p<0.001) and between the onset-anesthesia and the beginning-incision (p=0.021). There was no difference in time between patients with and without the use of checklists (p=0.05) in relation to the variables onset-anesthesia, onset-incision, time of anesthesia and surgery. Conclusion: the implementation of checklists potentially contributed to reduce the time of use of the operating room. The nonassociation of its use with the increase in the mean time of the processes in the operating room shows that its application does not interfere negatively in this indicator.

RESUMO Objetivo: analisar o impacto do uso de checklists no tempo médio dos processos operatórios de pacientes submetidos a artroplastias de quadril e joelho. Método: pesquisa transversal e analítica realizada entre novembro/2020 e março/2022 com consulta retrospectiva em amostra aleatória simples de 291 prontuários, distribuídos em três períodos (2010/2013/2016). Utilizou-se estatística descritiva e inferencial para análise dos dados; valores de p=0,05 indicaram significância. Resultados: houve redução do tempo de entrada-saída da sala cirúrgica (p=0,002), de cirurgia (p<0,001) e entre o início-anestesia e início-incisão (p=0,021). Não houve diferença no tempo entre os pacientes com e sem o uso dos checklists (p=0,05) com relação às variáveis início-anestesia, início-incisão, tempo de anestesia e de cirurgia. Conclusão: a implantação de checklists potencialmente contribuiu para reduzir o tempo de uso da sala cirúrgica. A não associação de seu uso ao aumento do tempo médio dos processos no centro cirúrgico mostra que sua aplicação não interfere negativamente nesse indicador.

Precarious work at a surgical center: implications for the organization and for the health of nursing workers / Trabajo precario em centro quirúrgico: implicaciones organizacionales para la salud del trabajador de enfermería / Trabalho precário em centro cirúrgico: implicações organizacionais e a saúde do trabalhador de enfermagem

ABSTRACT Objectives: to analyze the implications of precarious work for the organization of work and for the health of nursing professionals in a surgical center. Methods: qualitative, descriptive study in which the interview technique was applied on 30 nursing professionals from a surgical center in a university hospital located in the Southeast region of Brazil. The project was approved by the research ethics committee. Thematic content analysis was applied in the categorization of speeches. Results: precarious work in the surgical center negatively affects the organization of work due to staff turnover, loss of skilled talent, and the need for continuous training of temporary workers. It also affects the quality of care, leading to risks to patient safety and workers' health.Final Considerations: it is important to make work conditions less precarious in order to minimize staff turnover and promote the quality of the service offered and the health of the worker.

RESUMEN Objetivos: analizar las implicaciones del trabajo precario para la organización laboral y la salud de los profesionales de enfermería en un centro quirúrgico. Métodos: se trata de un estudio cualitativo, descriptivo, llevado a cabo mediante entrevista con 30 profesionales de enfermería en un centro quirúrgico de un municipio de la región sureste de Brasil. El proyecto fue aprobado por el comité de ética e investigación. En la categorización de las declaraciones, se aplicó el análisis de contenido temático. Resultados: la precarización en centros quirúrgicos interfiere negativamente en la organización del trabajo debido a la rotación de personal, la fuga de capital intelectual y la necesidad de capacitación continua de los trabajadores temporarios. Existe una interferencia en la calidad de la atención con riesgos para la seguridad de los pacientes y la salud de los trabajadores. Consideraciones Finales: se ratifica la importancia de apuntalar el trabajo con el intuito de minimizar la rotación laboral y promover la calidad del servicio brindado y la salud del trabajador.

RESUMO Objetivos: analisar as implicações do trabalho precário para a organização do trabalho e para a saúde dos profissionais de enfermagem em centro cirúrgico. Métodos: estudo qualitativo, descritivo no qual se utilizou a técnica de entrevista com 30 profissionais de enfermagem de centro cirúrgico em um hospital universitário situado em um município da região sudeste, Brasil. Projeto aprovado por comitê de ética e pesquisa. Na categorização dos depoimentos aplicou-se a análise de conteúdo temática. Resultados: a precarização em centro cirúrgico interfere negativamente na organização do trabalho devido a rotatividade de pessoal, a fuga de capital intelectual e a necessidade de treinamento contínuo dos trabalhadores temporários. Há interferência na qualidade da assistência com riscos para a segurança dos pacientes e a saúde dos trabalhadores. Considerações Finais: ratifica-se a relevância da desprecarização do trabalho no intuito de minimizar a rotatividade dos profissionais, promover a qualidade do serviço ofertado e a saúde do trabalhador.

Trabalho da equipe de enfermagem do bloco cirúrgico: riscos de danos à saúde / Work of the nursing team in the surgical center: risks to health / Trabajo del equipo de enfermería en el bloque quirúrgico: riesgos de daños a la salud

Objetivo: Analisar os riscos de danos à saúde relacionados ao trabalho da equipe de enfermagem no bloco cirúrgico de um hospital universitário do Sul do Brasil. Métodos: Estudo transversal com abordagem quantitativa. Os dados foram coletados entre os meses de novembro de 2017 e janeiro de 2018, por meio da aplicação de um instrumento de pesquisa com os trabalhadores da equipe de enfermagem do bloco cirúrgico de um hospital univer-sitário. Os dados foram submetidos à análise estatística. Resultados: Constatou-se que 85,4% eram mulheres, com idade média de 47,7 anos. Referente aos danos psicológicos relacionados ao trabalho, 91,5% apresentaram baixo risco e 8,5% apresentaram risco médio. Quanto aos danos sociais, 87,5% apresentaram baixo risco e 10,4% apresentaram risco médio. Quanto aos danos físicos, 29,2% apresentaram alto risco, 35,4% apresentaram risco médio e 33,3% apresentaram baixo risco. Conclusões: Observou-se risco alto e médio para danos físicos relacionados ao trabalho, evidenciando a necessidade de intervenções que visem à prevenção do adoecimento dos trabalhadores.

Objective: To analyze the risks to health related to the work of the nursing team in the operating room of a university hospital in southern Brazil. Methods: Cross-sectional study with a quantitative approach. Data were collected between November 2017 and January 2018, through a survey with workers of the nursing team in the surgical center of a university hospital. Data were submitted to statistical analysis. Results: It was found that 85.4% were women, with a mean age of 47.7 years. Regarding work-related psychological compromise, 91.5% were at low risk and 8.5% were at medium risk. As for social harm, 87.5% were at low risk and 10.4% were at medium risk. As for physical risk, 29.2% were at high risk, 35.4% at medium risk, and 33.3% at low risk. Conclusions: There was a high and medium risk for physical injuries related to work, highlighting the need for interventions aimed at preventing illness among workers.

Objetivo: Analizar los riesgos de daños a la salud relacionados con el trabajo del equipo de enfermería en el quirófano de un hospital uni-versitario del sur de Brasil. Métodos: Estudio transversal con enfoque cuantitativo. Los datos fueron recolectados entre noviembre de 2017 y enero de 2018, mediante la aplicación de un instrumento de investigación con trabajadores del equipo de enfermería en el bloque quirúrgico de un hospital uni-versitario. Los datos fueron sometidos a análisis estadístico. Resultados: Se encontró que el 85,4% eran mujeres, con una edad promedio de 47,7 años. En cuanto al daño psicológico relacionado con el trabajo, el 91,5% tenía riesgo bajo y el 8,5% riesgo medio. En cuanto al daño social, el 87,5% tuvo riesgo bajo y el 10,4% riesgo medio. En cuanto al daño físico, el 29,2% se encontraba en riesgo alto, el 35,4% en riesgo medio y el 33,3% en riesgo bajo. Conclusiones: Hubo alto y medio riesgo de lesiones físicas relacionadas con el trabajo, destacando la necesidad de intervenciones dirigidas a la preven-ción de enfermedades entre los trabajadores.

Checklist de cirurgias seguras: percepção da equipe de saúde / Safe surgery checklist: perception of the health team / Lista de verificación de cirugía segura: percepción del equipo de salud

Objetivo: analisar a percepção dos profissionais de saúde do centro cirúrgico acerca do uso do checklist de cirurgias seguras. Método: estudo descritivo-exploratório, com abordagem qualitativa, realizado com 29 profissionais da equipe cirúrgica de um hospital universitário do Centro-Oeste brasileiro. Dados obtidos por meio de entrevistas individuais, entre fevereiro e março de 2019, norteadas por instrumento semiestruturado. Realizada análise de conteúdo. Resultados: emergiram as categorias temáticas 'Prática e importância atribuída ao uso do checklist de cirurgias seguras pela equipe de saúde' e 'Perspectivas para o uso efetivo do checklist de cirurgias seguras na prática profissional'. Conclusão: Revelou-se uma prática incipiente do uso do checklist de cirurgias seguras, apesar de compreenderem sua importância, e verificou-se o reconhecimento de aspectos profissionais e organizacionais que precisam ser trabalhados para tornar a incorporação dessa ferramenta mais assertiva no processo de trabalho da instituição.

Objective: to analyze the perception of health professionals in the operating room regarding the use of the safe surgeries checklist. Method: descriptive-exploratory study, with a qualitative approach, carried out with 29 professionals from the surgical team of a university hospital in the Brazilian Midwest. Data obtained through individual interviews, between February and March 2019, guided by a semi-structured instrument. Content analysis performed. Results: thematic categories 'Practice and importance attributed to the use of the safe surgeries checklist by the health team' and 'Perspectives for the effective use of the safe surgeries checklist in professional practice' emerged. Conclusion: It was revealed an incipient practice of using the safe surgeries checklist, despite understanding its importance, and there was recognition of professional and organizational aspects that need to be worked on to make the incorporation of this tool more assertive in the work process of institution.

Objetivo: analizar la percepción de los profesionales de la salud en centro quirúrgico sobre el uso del checklist de cirugías seguras. Método: estudio descriptivo-exploratorio, con abordaje cualitativo, realizado con 29 profesionales del equipo quirúrgico de un hospital universitario del Medio Oeste brasileño. Datos obtenidos a través de entrevistas individuales, entre febrero y marzo de 2019, guiadas por un instrumento semiestructurado. Análisis de contenido realizado. Resultados: surgieron categorías temáticas 'Práctica e importancia atribuida al uso de la lista de verificación de cirugías seguras por parte del equipo de salud' y 'Perspectivas para el uso efectivo de la lista de verificación de cirugías seguras en la práctica profesional'. Conclusión: Se reveló una práctica incipiente de utilizar el checklist de cirugías seguras, a pesar de comprender su importancia, y se reconocieron aspectos profesionales y organizacionales que deben ser trabajados para hacer más asertiva la incorporación de esta herramienta en el proceso de trabajo de la institución.

The environment under the knife: A review of current Eco-surgical strategies and recommendations for Pakistan.

The healthcare sector at its core is based on the fundamentals belief to do no harm and bring about betterment in the lives of the people. Paradoxically, hospitals are one of the leading contributors to pollution, greenhouse gas (GHG) emissions and toxic waste material worldwide. Surgical care delivery is quite resource intensive, consuming significant amount of energy and equipment as well as producing large quantities of waste. With climate change being a global priority, it is crucial that hospitals re-evaluate the environmental impact of such practices. The current review was planned to identify areas of improvement in surgical care in terms of sustainability, as well as describe efficient and innovative strategies for hospitals in Pakistan to lessen their impact on the environment. The implementation of the 5 R's strategy for surgical care (Reduce, Reuse, Recycle, Rethink and Research) as well as general measures to improve energy efficiency, waste management and inter-sectoral collaboration will provide significant benefits to the environment and advance efforts to creating a more sustainable future for surgical healthcare in Pakistan.

Cribado nutricional en pacientes quirúrgicos en un hospital universitario / Nutritional screening in surgical patients at a university hospital

Objetivo: conocer la prevalencia de riesgo de desnutrición de los pacientes quirúrgicos hospitalizados de un hospital de tercer nivel. Método: estudio descriptivo transversal unicéntrico con pacientes quirúrgicos hospitalizados. Se realizó un cálculo de tamaño muestral de 323 pacientes y se reclutaron por conveniencia. Se analizó el riesgo de desnutrición con la escala Nutrition Risk Screening 2002 y su asociación con diferentes variables sociodemográficas y clínicas. Para el análisis de datos se aplicaron las pruebas de Chi cuadrado, prueba exacta de Fisher, t de Student y U de Mann Whitney con una significancia estadística de p< 0,05. Resultados: participaron 318 pacientes, de los cuales el 74,8% era hombre, con una edad media de 62,2 años (DE: 15,54). En el cribado inicial, 80 participantes (25,2%) presentaron riesgo potencial de desnutrición mientras que tras el screening final, solo 12 presentaron riesgo de desnutrición real (3,8%). No se halló relación entre la desnutrición y el sexo aunque sí con la edad, aumentando el riesgo proporcionalmente (p< 0,001). Otros factores asociados fueron la necesidad de un cuidador/a (p= 0,001), el tipo de patología de ingreso (p= 0,034) y tener antecedentes personales oncológicos (p< 0,001) y de deterioro cognitivo (p= 0,001). Conclusiones: la prevalencia de desnutrición en pacientes quirúrgicos hospitalizados es baja y parece que aumenta con la edad, y con antecedentes personales de deterioro cognitivo y enfermedad neoplásica, aunque los resultados deben ser interpretados con cautela. Identificar la presencia de desnutrición al ingreso favorece el fomento de medidas de prevención que permitan implementar un plan nutricional y facilitar el seguimiento tras el alta.(AU)

Objectives: to understand the prevalence of the risk of malnutrition among hospitalized surgical patients in a tertiary hospital. Method: a descriptive cross-sectional single-centre study with hospitalized surgical patients. The sample size was calculated at 323 patients, and there was convenience recruitment. The malnutrition risk was analysed with the Nutrition Risk Screening 2002 scale, and its association with different sociodemographic and clinical variables. The Chi Square, Fisher’s Exact, Student’s t and Mann-Whitney tests were applied for data analysis, with a statistical significance of p< 0.05. Results: the study included 318 patients; 74.8% of them were male, with a mean age of 62.2 years (SD: 15.54). At the initial screening, 80 participants (25.2%) presented potential risk of malnutrition; while after the final screening, only 12 presented a real risk of malnutrition (3.8%). No relationship was found between malnutrition and gender, but it was found with age, with a proportional increase in risk (p< 0.001). Other factors associated were the need for a caregiver (p= 0.001), the type of condition at admission (p= 0.034) and having a personal background of neoplasia (p< 0.001) and cognitive deterioration (p= 0.001). Conclusions: there is a low prevalence of malnutrition among hospitalized surgical patients, and it seems to increase with age and with a personal history of cognitive deterioration and neoplasia, although these results must be interpreted with caution. The detection of malnutrition at admission will promote taking prevention measures, therefore allowing to implement a nutritional plan and facilitating follow-up after discharge.(AU)

Application effect of simulation teaching combined with CBL mode on the practice of thoracic surgery nursing students / 中华医学教育探索杂志

Objective:To explore the effect of simulation teaching combined with case-based learning (CBL) on the practice of thoracic surgery nursing students.Methods:Cluster sampling method was adopted to select 30 practice nurses of the thoracic surgery department of 2019 as the control group, and traditional teaching was adopted. Another 30 thoracic surgery practice nurses of 2020 were selected as the research group, and simulation teaching combined with CBL was adopted. After the training, the two groups of practice nurses were assessed on theory and basic skills, and the nurses' recognition of teaching was assessed through questionnaire surveys. SPSS 22.0 was used for t test and chi-square test. Results:After the training of practical nurses, the research group had better performances of theoretical and basic skills tests than the control group, with significant differences ( P<0.001). The practice nurses of the research group did significantly better than those of the control group in such 8 dimensions as improving basic nursing skills, improving autonomous learning ability, improving the clinical thinking ability, enhancing our emergency response ability, improving the ability of theory combined with practice, improving training interest in learning, training team cooperation ability, cultivating the ability of doctor-patient communication and so on ( P<0.05). Conclusion:The combination of simulation teaching and CBL applied in the practice of thoracic surgery nursing students can improve the proficiency of nurses' nursing skills and improve the quality of clinical teaching.

La evaluación preoperatoria en intervenciones quirúrgicas no cardiacas en el Hospital de Especialidades Carlos Andrade Marín / Preoperative evaluation of non-cardiac surgical interventions at Carlos Andrade Marín Specialties Hospital

INTRODUCCIÓN. La evaluación preoperatoria determina el estado de salud del paciente que será sometido a una intervención quirúrgica, minimiza su riesgo y optimiza los recursos humanos y materiales del escenario perioperatorio. OBJETIVO. Determinar el proceso de evaluación preoperatorio y su capacidad para prevenir eventos clínicos adversos durante el postoperatorio inmediato de pacientes adultos sometidos a un procedimiento quirúrgico no cardiaco. MATERIALES Y MÉTODOS. Estudio retrospectivo de corte transversal. Población de 6 250 adultos y muestra de 912 Historias Clínicas electrónicas de pacientes atendidos en el Hospital de Especialidades Carlos Andrade Marín, en el año 2017. Criterios de inclusión: pacientes mayores de 18 años, que se sometieron a una evaluación preoperatoria de manera ambulatoria y fueron operados de intervenciones no cardiacas hasta el mes de enero del 2019, o suspensión de cirugía por contraindicaciones determinadas en la cita médica. Criterios de exclusión: pacientes menores a 18 años, no intervenidos quirúrgicamente, hospitalizados por cualquier motivo entre la revisión y la cirugía, embarazadas e individuos con consulta preoperatoria fuera del hospital. Los programas informáticos utilizados para el registro de datos y su análisis fueron Microsoft Excel e International Business Machines Statistical Package for the Social Sciences. RESULTADOS. El 82,68% (754; 912) presentó un antecedente clínico y el 82,13% (749; 912) uno de tipo quirúrgico. Se reportó un 2,00% (18; 912) de complicaciones postoperatorias, y un caso de muerte pasadas las 72 horas postquirúrgicas. No se encontró correlación estadísticamente significativa p>0,05 entre las conclusiones clínicas del control preoperatorio y la ocurrencia de complicaciones en el postoperatorio. CONCLUSIÓN. Se evidenció que el proceso de evaluación preoperatoria fue realizado de manera sistemática a pacientes con características sociodemográficas y clínicas heterogéneas y no existió correlación estadística entre sus resultados y la presencia de complicaciones perioperatorias.

INTRODUCTION. The preoperative evaluation determines the health status of a patient that will undergo a surgical intervention, minimizes its risk, and optimizes the human and material resources of the perioperative scenario. OBJECTIVE. To determine the preoperative evaluation process and its ability to prevent adverse clinical events during the immediate postoperative period in adult patients undergoing a noncardiac surgical procedure. MATERIALS AND METHODS. This is a retrospective cross-sectional study. The sample of 912 medical records was calculated upon a population of 6 250 adults treated at the Carlos Andrade Marín Specialties Hospital in 2017. Inclusion criteria: patients over 18 years of age, who underwent a preoperative evaluation on an outpatient basis, and were operated on for non-cardiac interventions until January 2019, or suspension of surgery due to contraindications determined in the medical appointment. Exclusion criteria: patients under 18 years of age, not undergoing surgery, hospitalized for any reason between revision and surgery, pregnant women, and individuals with preoperative consultation outside the hospital. The computer programs used for data collection and analysis were Microsoft Excel and the International Business Machines Statistical Package for the Social Sciences. RESULTS. 82,68% (754; 912) had a previous clinical condition and 82,13% (749; 912) had a previous surgical intervention. 2,00% (18; 912) of postoperative complications were reported, and one case of death after 72 postoperative hours. No statistically significant correlation p>0,05 was found between the clinical conclusions of the preoperative control and the occurrence of postoperative complications. CONCLUSION. It was evidenced that the preoperative evaluation process was carried out systematically to patients with heterogeneous sociodemographic and clinical characteristics and there was no statistical correlation between its results and the presence of perioperative complications.

Prevalência de suspensões cirúrgicas eletivas em um hospital público do sul do Brasil / Prevalence of suspension of elective surgeries in a public hospital in south Brazil / Prevalencia de suspensiones quirúrgicas electivas en un hospital público del sur de Brasil

Objetivo: Caracterizar a prevalência e as causas de suspensão das cirurgias eletivas considerando determinantes clínicos e não clínicos. Método: Estudo exploratório, retrospectivo, quantitativo. A coleta de dados foi realizada no banco eletrônico de um hospital público do Sul do Brasil, no período entre janeiro de 2018 e dezembro de 2019. Consideraram-se as variáveis sexo, faixa etária, quantitativo de cirurgias, especialidade médica e motivos da suspensão das cirurgias e realizou-se análise estatística descritiva. Resultados: Das 11.792 (100,0%) cirurgias programadas, 2.170 (18,4%) foram suspensas. As especialidades cirúrgicas com maior taxa de suspensão foram ortopedia (32,6%) e cirurgia geral (19,0%), tendo como principais motivos não clínicos: prioridade para urgência (21,5%), falta de vaga em unidade terapia intensiva (15,6%) e não comparecimento do paciente (13,6%). O principal motivo clínico de suspensão cirúrgica foi condição clínica desfavorável (8,7%). Conclusão: O estudo contribuiu para a avaliação dos indicadores de qualidade relacionados aos agendamentos e às suspensões cirúrgicas no Centro Cirúrgico, além de oportunizar a criação de estratégias de melhoria contínua.

Objective: To characterize the prevalence and causes of suspension of elective surgeries considering clinical and non-clinical factors. Method: Exploratory, retrospective, quantitative study. Data were collected in the electronic database of a public hospital in southern Brazil between January 2018 and December 2019. The variables gender, age group, number of surgeries, medical specialty and reasons for suspending surgeries were assessed, and a descriptive statistical analysis was performed. Results: Of the 11,792 (100.0%) scheduled surgeries, 2,170 (18.4%) were suspended. The surgical specialties that most suspended surgeries were orthopedics (32.6%) and general surgery (19.0%), the main non-clinical factors being: priority for urgency (21.5%), lack of vacancy in the intensive care unit (15.6%) and no attendance of the patient (13.6%). The main clinical reason for surgical suspension was clinical unfavorable condition (8.7%). Conclusion: This study contributed to the assessment of quality indicators related to the scheduling and suspension of surgical procedures in the Surgical Center, in addition to providing opportunities for the creation of clinic continuous improvement.

Objetivo: Caracterizar la prevalencia y causas de suspensión de cirugías electivas considerando determinantes clínicos y no clínicos. Método: Estudio exploratorio, retrospectivo, cuantitativo. La recolección de datos se realizó en la base de datos electrónica de un hospital público del sur de Brasil, de enero de 2018 a diciembre de 2019. Se realizaron las variables sexo, edad, número de cirugías, especialidad médica y motivos de suspensión de cirugías y análisis estadístico descriptivo. Resultados: De las 11.792 (100,0%) cirugías programadas, 2.170 (18,4%) fueron suspendidas. Las especialidades quirúrgicas con mayor tasa de suspensión fueron Ortopedia (32,6%) y Cirugía general (19,0%), con las principales razones no clínicas: prioridad por urgencia (21,5%), falta de espacio en la unidad de cuidados intensivos (15,6%) y no asistencia de pacientes (13,6%). El principal motivo clínico de la interrupción quirúrgica fue una situación clínica desfavorable (8,7%). Conclusión: El estudio contribuyó a la evaluación de indicadores de calidad relacionados con la programación y suspensiones quirúrgicas en el Centro Quirúrgico, además de brindar oportunidades para la creación de estrategias de mejora continua.

Conocimiento respecto del consentimiento informado en médicos especialistas del área quirúrgica de un hospital en Chile / Knowledge of informed consent in specialists from the surgery department of a hospital in chile / Conhecimento sobre o consentimento informado em médicos especialistas da área cirúrgica de um hospital no chile

Resumen La ley de derechos y deberes de los usuarios en salud, promulgada en Chile en 2012, ha llevado a posicionar el proceso de consentimiento informado como un aspecto importante para el respeto de su autonomía. Por este motivo, resulta pertinente evaluar los conocimientos que tiene el personal médico respecto de esta temática, especialmente en el área quirúrgica. Se llevó a cabo un estudio cuantitativo en 90 médicos especialistas del área quirúrgica en un hospital público de alta complejidad, a quienes se les aplicó un cuestionario para evaluar sus conocimientos sobre el consentimiento informado. Se encontró que el 76,6 % de los encuestados tenía un nivel de conocimiento deficiente, lo cual crea un escenario en el que se pueden vulnerar los derechos de los usuarios.

Abstract The Patients' Rights and Duties Act, promulgated in Chile in 2012, has made the informed consent process a critical step to respect the patient's autonomy. It is then relevant to test health workers' knowledge of the subject, especially in the surgery department. We carried out a quantitative study on 90 specialists from the surgery department in a public tertiary hospital, to whom a questionnaire was administered to test their knowledge of informed consent. We found that 76.6 % of the respondents have a low level of knowledge, creating a setting in which patients' rights can be violated.

Resumo A lei de direitos e deveres dos usuários em saúde, promulgada no Chile em 2012, tem posicionado o processo de consentimento informado como aspecto importante para o respeito de sua autonomia. Por esse motivo, é pertinente avaliar o conhecimento que a equipe médica tem sobre essa temática, especialmente na área cirúrgica. Foi realizado estudo quantitativo com 90 médicos especialistas da área cirúrgica em um hospital público de alta complexidade, aos quais foi aplicado questionário para avaliar seu conhecimento sobre o consentimento informado. Foi constatado que 76,6 % dos entrevistados tinham nível de conhecimento deficiente, o que cria um cenário no qual podem ser violados os direitos dos usuários.

Manejo de aerossóis durante a pandemia da COVID-19 / Aerosol management during the COVID-19 pandemic / Manejo de aerosol durante la pandemia COVID-19

Objetivo: Descrever o processo de prototipação de um dispositivo de filtragem para manejo de aerossóis em procedimentos laparoscópicos durante a pandemia do coronavírus SARS-CoV-2. Método: Estudo descritivo, tipo relato de experiência sobre o protótipo de dispositivo de filtragem para manejo de aerossóis em laparoscopia durante a pandemia de COVID-19 pelo SARS-CoV-2, com base nos processos de imersão, ideação e prototipação do design thinking. Resultados: Os processos de imersão preliminar e profunda permitiram a abordagem do problema. A utilização do mapa mental proporcionou a identificação dos fatores relacionados às suspensões de cirurgias em decorrência do SARS-CoV-2. Pelas medidas do aspirador das salas cirúrgicas, idealizaram-se os recursos materiais necessários: extensor de aspiração, filtro bacteriológico e viral, conector e ponteira. Conclusão: O dispositivo para filtragem do dióxido de carbono do pneumoperitônio obteve boa aceitação da equipe cirúrgica e foi incorporado à rotina do setor durante a realização de cirurgias laparoscópicas.

Objective: To describe the prototyping process of a filtration device for aerosol management in laparoscopic procedures during the SARSCoV-2 coronavirus pandemic. Method: Descriptive study with the report of experience on the prototype filter device for aerosol management in laparoscopy during the SARS-CoV-2 COVID-19 pandemic, based on immersion, ideation and design thinking prototyping processes. Results: Preliminary and deep immersion processes allowed the problem to be addressed. The use of a mental map helped to identify factors related to surgery suspensions due to the SARS-CoV-2. Based on the measurements of the operating room aspirator, the necessary material resources were idealized: suction extender, bacteriological and viral filter, connector and tip. Conclusion: The device for filtering carbon dioxide from the pneumoperitoneum was well accepted by the surgical team and incorporated into the sector's routine for laparoscopic surgeries.

Objetivo: Describir el proceso de prototipado de un dispositivo de filtración para el manejo de aerosol en procedimientos laparoscópicos durante la pandemia de Coronavirus SARS-CoV-2. Método: Estudio descriptivo, un relato de experiencia sobre el prototipo de dispositivo de filtrado para el manejo de aerosol en laparoscopia durante la pandemia de COVID-19 por SARS-CoV-2, a partir de los procesos de inmersión, ideación y prototipado del Design Thinking. Resultados: Los procesos de inmersión profunda y preliminar permitieron abordar el problema. El uso del Mapa Mental permitió identificar los factores relacionados con la suspensión de cirugías debido al SARS-CoV-2. A partir de las mediciones del aspirador de las salas quirúrgicas, se idearon los recursos materiales necesarios: extensor de aspiración, filtro bacteriológico y viral, conector y férula. Conclusión: El dispositivo para filtrar dióxido de carbono del neumoperitoneo obtuvo buena aceptación por parte del equipo quirúrgico y fue incorporado a la rutina del sector durante las cirugías laparoscópicas.