Imperial College London
Alternate

ProfessorGeorgeHanna

Faculty of Medicine, Department of Surgery & Cancer

Head of Department of Surgery and Cancer
 
 
 
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Contact

 

+44 (0)20 7594 3396g.hanna

 
 
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Assistant

 

Ms Aoibheann Byrne +44 (0)20 7594 3396

 
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Location

 

Block B Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Curtis:2021:10.1097/SLA.0000000000003452,
author = {Curtis, NJ and Dennison, G and Brown, CSB and Hewett, PJ and Hanna, GB and Stevenson, ARL and Francis, NK},
doi = {10.1097/SLA.0000000000003452},
journal = {Annals of Surgery},
pages = {778--784},
title = {Clinical evaluation of intraoperative near misses in laparoscopic rectal cancer surgery.},
url = {http://dx.doi.org/10.1097/SLA.0000000000003452},
volume = {273},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - OBJECTIVE: To investigate the frequency, nature, and severity of intraoperative adverse near miss events within advanced laparoscopic surgery and report any associated clinical impact. BACKGROUND: Despite implementation of surgical safety initiatives, the intraoperative period is poorly documented with evidence of underreporting. Near miss analyses are undertaken in high-risk industries but not in surgical practice. METHODS: Case video and data from 2 laparoscopic total mesorectal excision randomized controlled trials were analyzed (ALaCaRT ACTRN12609000663257, 2D3D ISRCTN59485808). Intraoperative adverse events were identified and categorized using the observational clinical human reliability analysis technique. The EAES classification was applied by 2 blinded assessors. EAES grade 1 events (nonconsequential error, no damage, or need for correction) were considered near misses. Associated clinical impact was assessed with early morbidity and histopathology outcomes. RESULTS: One hundred seventy-five cases contained 1113 error events. Six hundred ninety-eight (62.7%) were near misses (median 3, IQR 2-5, range 0-15) with excellent inter-rater and test-retest reliability (κ=0.86, 95% CI 0.83-0.89, P < 0.001 and κ=0.88, 95% CI 0.85-0.9, P < 0.001 respectively). Significantly more near misses were seen in patients who developed early complications (4 (3-6) vs. 3 (2-4), P < 0.001). Higher numbers of near misses were seen in patients with more numerous (P = 0.002) and more serious early complications (P = 0.003). Cases containing major intraoperative adverse events contained significantly more near misses (5 (3-7) vs. 3 (2-5), P < 0.001) with a major event observed for every 19.4 near misses. CONCLUSION: Intraoperative adverse events and near misses can be reliably and objectively captured in advanced laparoscopic surgery. Near misses are commonplace and closely associated with morbidity outcomes.
AU  - Curtis,NJ
AU  - Dennison,G
AU  - Brown,CSB
AU  - Hewett,PJ
AU  - Hanna,GB
AU  - Stevenson,ARL
AU  - Francis,NK
DO  - 10.1097/SLA.0000000000003452
EP  - 784
PY  - 2021///
SN  - 0003-4932
SP  - 778
TI  - Clinical evaluation of intraoperative near misses in laparoscopic rectal cancer surgery.
T2  - Annals of Surgery
UR  - http://dx.doi.org/10.1097/SLA.0000000000003452
UR  - https://www.ncbi.nlm.nih.gov/pubmed/31274657
UR  - https://insights.ovid.com/crossref?an=00000658-900000000-95052
UR  - http://hdl.handle.net/10044/1/72484
VL  - 273
ER  -
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