EAES classification of intraoperative adverse events in laparoscopic surgery

被引:37
作者
Francis, N. K. [1 ,2 ]
Curtis, N. J. [1 ,3 ]
Conti, J. A. [4 ,5 ]
Foster, J. D. [1 ,3 ]
Bonjer, H. J. [6 ]
Hanna, G. B. [3 ]
机构
[1] Yeovil Dist Hosp NHS Fdn Trust, Dept Gen Surg, Higher Kingston BA21 4AT, Yeovil, Somalia
[2] Univ Bath, Fac Sci, Wessex House 3-22, Bath BA2 7AY, Avon, England
[3] St Marys Hosp, Imperial Coll London, Dept Surg & Canc, Level 10,Praed St, London W2 1NY, England
[4] Queen Alexandra Hosp, Dept Colorectal Surg, Portsmouth PO6 3LY, Hants, England
[5] Univ Southampton, Southampton Gen Hosp, Acad Surg Unit, Level C, Southampton SO16 6YD, Hants, England
[6] Vrije Univ Amsterdam, Med Ctr, Dept Surg, NL-1081 HV Amsterdam, Netherlands
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2018年 / 32卷 / 09期
关键词
Adverse events; Classification; Laparoscopic; Morbidity; Intraoperative; EAES; HUMAN RELIABILITY-ANALYSIS; RANDOMIZED CLINICAL-TRIAL; COMPLETE MESOCOLIC EXCISION; NATIONAL-TRAINING-PROGRAM; RECTAL-CANCER SURGERY; COLORECTAL-SURGERY; SURGICAL COMPLICATIONS; PATHOLOGICAL OUTCOMES; COMPETENCE ASSESSMENT; ASSISTED RESECTION;
D O I
10.1007/s00464-018-6108-1
中图分类号
R61 [外科手术学];
学科分类号
摘要
Surgical outcomes are traditionally evaluated by post-operative data such as histopathology and morbidity. Although these outcomes are reported using accepted systems, their ability to influence operative performance is limited by their retrospective application. Interest in direct measurement of intraoperative events is growing but no available systems applicable to routine practice exist. We aimed to develop a structured, practical method to report intraoperative adverse events enacted during minimal access surgical procedures. A structured mixed methodology approach was adopted. Current intraoperative adverse event reporting practices and desirable system characteristics were sought through a survey of the EAES executive. The observational clinical human reliability analysis method was applied to a series of laparoscopic total mesorectal excision (TME) case videos to identify intraoperative adverse events. In keeping with survey results, observed events were further categorised into non-consequential and consequential, which were further subdivided into four levels based upon the principle of therapy required to correct the event. A second survey phase explored usability, acceptability, face and content validity of the novel classification. 217 h of TME surgery were analysed to develop and continually refine the five-point hierarchical structure. 34 EAES expert surgeons (69%) responded. The lack of an accepted system was the main barrier to routine reporting. Simplicity, reproducibility and clinical utility were identified as essential requirements. The observed distribution of intraoperative adverse events was 60.1% grade I (non-consequential), 37.1% grade II (minor corrective action), 2.4% grade III (major correction or change in post-operative care) and 0.1% grade IV (life threatening). 84% agreed with the proposed classification (Likert scale 4.04) and 92% felt it was applicable to their practice and incorporated all desirable characteristics. A clinically applicable intraoperative adverse event classification, which is acceptable to expert surgeons, is reported and complements the objective assessment of minimal access surgical performance.
引用
收藏
页码:3822 / 3829
页数:8
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