Trends in the Staff's Perception of Patient Safety Culture in Romanian Hospitals.

INTRODUCTION: The IRIS-2 project (2019) expanded the application of the HSOPSC in Romanian hospitals, yet applied, for the first time in the country, in 2014 (IRIS-1). The aim is an update on patient safety culture for staff, by geographic region and overall, by year of survey. MATERIALS AND METHODS: A cross-sectional study was carried out in voluntary staff in four hospitals in four regions (n. 1,121 staff) and compared with a previous study based on six hospitals in four regions (n. 969 staff). The instrument was the Romanian version of the HSOPSC with 31 items and 9 dimensions. Statistics to analyze trend were computed using "R". Results No significant differences between the proportion of positive response (PPRs) by dimension were observed in IRIS-2 with respect to IRIS-1, with two exceptions: significantly lower PPR for "teamwork across hospital units" (65% versus 73%) and significantly higher PPR for "frequency of events reporting" (65% versus 59%). Four dimensions were well developed and five dimensions needed to be improved. The poorest PPRs were for the "teamwork across hospital units", the "frequency of event reporting" and the "non punitive response to error" dimensions. Besides, one outcome indicator changed through time: the proportion of the staff who did not report any event was significantly lower (64% versus 73%) and the proportion of the staff who reported "1-2 events" was significantly higher (21% versus 15%). CONCLUSION: Despite some small progress related to the frequency of events reporting, there is room for further patient safety culture improvement.

The Effect of Postoperative Nonsteroidal Anti-inflammatory Drugs on Nonunion Rates in Long Bone Fractures.

The association of nonsteroidal anti-inflammatory drugs (NSAIDs) with non-union in long bone fractures has been controversial. The purpose of this study was to evaluate whether NSAID exposure results in increased risk of non-union in operatively treated long bone fractures. The authors used International Classification of Diseases and Current Procedural Terminology codes to identify patients under a single-payer private insurance with operatively treated humeral shaft, tibial shaft, and subtrochanteric femur fractures from a large database. Patients were divided into cohorts based on NSAID use in the immediate postoperative period, and nonunion rates were compared. A cost analysis and a multivariate analysis were performed. Between 2007 and 2016, a total of 5310 tibial shaft, 3947 humeral shaft, and 8432 subtrochanteric femur fractures underwent operative fixation. Patients used NSAIDs in the first 90 days postoperatively in 900 tibial shaft, 694 humeral shaft, and 967 subtrochanteric femur fractures. In these patients, nonunion rates were 18.8%, 17.4%, and 10.4%, respectively. When no NSAIDs were used, the rates were 11.4%, 10.1%, and 4.6% for each fracture type, respectively (P<.05). Among patients taking NSAIDs, subtrochanteric femur fractures had a 2.4 times higher risk of nonunion and humeral shaft and tibial shaft fractures both had a 1.7 times higher risk of nonunion (P<.05). Multivariate analysis showed NSAID use to be an independent risk factor in all 3 types. Cost analysis showed a great increase in economic burden (P<.05). This study indicated that NSAID exposure was associated with fracture nonunion. [Orthopedics. 2020;43(4):221-227.].

Anterior pelvic external fixator versus subcutaneous internal fixator in the treatment of anterior ring pelvic fractures.

OBJECTIVES: To compare the short-term results of anterior pelvic external fixation (APEF) versus anterior pelvic internal fixation (APIF) applied subcutaneously in the context of surgical treatment of pelvic ring injuries. DESIGN: A single center retrospective chart review. SETTING: A level 1 trauma center. METHODS: A consecutive series of 48 patients who underwent surgical stabilization of their anterior pelvic ring (24 utilizing APIF and 24 utilizing APEF) by 2 surgeons at a single hospital were studied. The choice to use either APEF or APIF was left up to each surgeon, the indications for use are the same. Data collected included surgical or postoperative complications including infection, implant failure, reoperation, documented surgical site pain persisting to clinical follow-up visits, and radiographic union. Measurements on inlet and outlet pelvic radiographs were made immediately postoperation and at all follow-up clinic visits to determine whether there were differences in maintaining pelvic fracture reduction. Statistical analysis was performed to evaluate significant differences between the 2 groups with regard to each of these variables. RESULTS: The APIF group was found to have a significantly lower incidence of wound complication (P < 0.05) and a lower occurrence of associated morbidity events as compared with the APEF group. In addition, the APIF group was found to have a significantly lower rate of surgical site pain persisting through all clinical follow-up intervals (P = 0.05). There was no difference between the 2 groups in terms of maintenance of pelvic reduction in the early postoperative phase or at final follow-up. No other significant differences were observed between the 2 groups. CONCLUSIONS: The present study, which was based on our initial experience with the subcutaneous anterior pelvic fixator, demonstrated encouraging clinical outcomes in terms of a lower wound complication rate and associated morbidity, and surgical site symptoms, although maintaining equivalent reduction. These findings suggest that further analysis of this technique is warranted to determine if it can be definitively recommended for general use. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Anterior pelvic subcutaneous internal fixator application: an anatomic study.

OBJECTIVES: To determine what anatomic structures are at risk after the application of a subcutaneous anterior pelvic internal fixator (APIF), from an incision over the anterior iliac crest to an incision centered over the pubic symphysis (Pfannenstiel). METHODS: A laboratory investigation was performed using 5 fresh, frozen, nonpreserved cadaveric specimens (3 male specimens, 2 female specimens). Dissections were carried out to identify the relationships and proximity between the fixator screw constructs and various anatomic structures, including the (1) lateral femoral cutaneous nerve (LFCN), (2) ilioinguinal nerve (IIN), (3) iliohypogastric nerve (IHN), (4) femoral nerve, (5) femoral artery, (6) femoral vein, (7) genitofemoral nerve; and (8) spermatic cord or round ligament. The mean and range of distance from each of these structures to the implant were measured with calipers. RESULTS: Despite variations in pelvic anatomy and width of pelvic brims, precontoured fixators (3.5 locking reconstruction plates) did not violate any pelvic neurovascular structures using this recommended application of an APIF. The spermatic cord was easily avoided as they were directly visualized using our application technique (mean, 0.4 cm, range, 0-2 cm). Abdominal musculature protected the IHN and IIN for most of their course, with the precontoured plates remaining inferior to their course and resting superficial to their branches (IHN mean, 1.5 cm, range, 1.2-1.8 cm and IIN mean, 2.1 cm, range, 0.9-4 cm). The LFCN traveled safely posterior to the inguinal ligament, thus being bridged by the internal spanning fixation without visualized disruption, impingement, or violation (mean, 1.5 cm, range, 0.6-4 cm). Finally, the femoral nerve, artery, and vein collectively demonstrated safe distance from the risk of compression (mean, 2.2 cm, range, 0.8-3.7 cm). CONCLUSIONS: The anatomic structures hypothesized to be potentially endangered because of the lack of direct visualization during APIF placement, include the LFCN, IIN, IHN, femoral nerve, femoral artery, and femoral vein. Based upon our anatomic study, APIF, which may be used for treatment augmentation of anterior pelvic ring disruptions, does not place these structures at significant risk. In addition, the reproductive structures (round ligament and spermatic cord) are in direct visualization and can easily be avoided during implant placement.