Postoperative video debriefing reduces technical errors in laparoscopic surgery.
ABSTRACT Because of the learning curve required to master laparoscopic procedures, there is a growing concern that patient safety may be compromised due to technical errors by a novice surgeon. We evaluated the effect of videotape debriefing on the performance of a complex laparoscopic procedure.
Twenty-four surgical residents performed a laparoscopic jejunojejunal anastomosis under the supervision of a single laparoscopic surgeon. All procedures were videotaped. Half of the residents underwent video debriefing. Videotapes were analyzed for knot-tying time, anastomotic time, and frequency of minor technical errors and adverse events. The performance of the debriefed group was compared with a non-debriefed group.
Knot-tying time, minor errors, and anastomotic time were similar between the debriefed and non-debriefed groups. However, adverse events from technical errors were more frequent in the non-debriefed group (chi2 = 7.647, P = .006).
Postoperative video debriefing is an effective educational tool for reducing adverse events during a complex laparoscopic procedure.
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ABSTRACT: Laparoscopic gastric bypass (GBP) is becoming a common approach for treatment of morbid obesity. We analyzed preoperative factors that may be associated with operative outcomes in laparoscopic GBP. This prospective study evaluates 150 consecutive laparoscopic GBP procedures performed by a single surgeon. Preoperative factors were grouped into three categories: 1) patient-specific (gender, age, abdominal surgical history, smoking), 2) obesity-specific (body mass index, hypertension, diabetes, sleep apnea), and 3) procedure-specific (operative experience of the surgeon [75 cases or less versus more than 75 cases]). Length of operation (240 minutes or less versus more than 240 minutes), postoperative complications (yes versus no), major complications (yes versus no), reoperation (yes versus no), and length of hospital stay (4 days or less versus more than 4 days) were the operative outcomes considered. In this series all patients who had a major complication required a reoperation. Data were analyzed using univariate and multiple logistic regression analyses. Operative experience of surgeon (75 cases or less) was associated with lengthy operative time (adjusted odds ratio [AOR], 3.8; 95% confidence interval [CI], 1.7 to 8.3), major complications (AOR, 15.0; 95% CI, 1.5 to 143.0), and a lengthy (more than 4 days) hospital stay (AOR, 4.5; 95% CI, 1.1 to 18.0). Higher patient age (50 years or more) was associated with more postoperative complications (AOR, 11.4; 95% CI, 3.0 to 43.1) and major complications (AOR, 7.6; 95% CI, 1.1 to 48.7). Male gender also was associated with more postoperative complications (AOR 5.2; 95% CI, 1.1 to 23.1). Obesity-related comorbidities, body mass index, past abdominal surgical history, and smoking had no statistical association with operative outcomes in this study. There is an association of clinical outcomes after laparoscopic GBP with the age and gender of the patient and the operative experience of the surgeon. An operative experience of more than 75 laparoscopic GBP cases was associated with decreases in operative time, length of hospital stay, and number of major complications.Journal of the American College of Surgeons 11/2003; 197(4):548-55; discussion 555-7. · 4.50 Impact Factor
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ABSTRACT: New Accreditation Council for Graduate Medical Education (ACGME) requirements on resident duty hours are scheduled to undergo nationwide implementation in July 2003. General surgery residents, because of their long duty hours, are likely to be among those most affected by changes imposed to comply with the ACGME requirements. There are few contemporary data on their attitudes toward work hours reform. The study entailed a region-wide survey of residents enrolled in general surgery residencies in New England to characterize the perceptions and desires of surgical residents on the issue of work hours reform. Respondents reported working a mean of 105 +/- 0.7 hours per week, considerably more than the 80-hour limit stipulated by the ACGME. Of the respondents, 81% reported that sleep deprivation had negatively affected their work. A strong majority of respondents believe that work hours reform would improve their quality of life but less than one half expect it to have a positive impact on patient care. A greater percentage of senior residents than junior residents (p < 0.05) have negative perceptions of work hour limitations, particularly with respect to consequences for patient care. Other findings suggest that residents who have actually experienced work hour restrictions are less positive about such restrictions than these residents who had not yet experienced them. Changes imposed by residency programs to comply with work hour requirements might have detrimental effects on senior residents and patient care. The impact of such changes should be carefully monitored as the ACGME requirements are implemented.Journal of the American College of Surgeons 10/2003; 197(4):624-30. · 4.50 Impact Factor
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ABSTRACT: In July 2003, the Accreditation Council for Graduate Medical Education implemented nationwide requirements on resident duty hours with the aim of improving quality of care. Our objectives were (1) to determine the extent and means of compliance with the ACGME requirements within general surgery residency programs and (2) to examine general surgery residents' perceptions of the effects of the ACGME requirements on patient care and residents' training experience. A survey was mailed to residents in 19 New England general surgery programs in spring 2004 (n=238). The overall response rate was 36%. More than 89% of respondents reported that the requirements generally were being enforced, and respondents' mean work hours (80.8 +/- 11.7 per week) supported this claim. Forty-three percent felt that quality of care had deteriorated. Although 70% perceived decrements in continuity of care, only 32% believed that the risk of patient management errors had increased. Sixty percent reported doing fewer operations, and half felt that residents missed out on too many learning opportunities. Yet, only 39% reported that the requirements had worsened the quality of training. Residents consistently reported an improved quality of life. Seventy-five percent felt that, overall, the requirements were a good thing. Most surgical residents do not believe that the ACGME duty hour requirements have had their intended effect of improving quality of care and are ambivalent about effects on the quality of their training. However, they report an improved quality of life, and most residents do support the requirements overall.Surgery 09/2005; 138(2):246-53. · 3.37 Impact Factor
Giselle G Hamad