Literature selections curated by Lewis Flint, MD, FACS, and reviewed by the ACS Brief editorial board.
Multifactorial Quality Improvement Decreases Retained Foreign Objects in OR
Keane OA, Chambers C, Brady CM, et al. Reducing Retained Foreign Objects in the Operating Room: A Quality Improvement Initiative. J Am Coll Surg. 2023; in press.
Editorial: Raval MV. Making Operating Rooms Safer: Communication and Teamwork but Investment in Technologies Is Needed. J Am Coll Surg. 2023; in press.
Although retained foreign object events are unusual in pediatric surgery, they are the most common “never event”—an event that should never happen during surgery—reported to The Joint Commission. The most common retained objects are “soft,” such as sponges, packing, and towels, and these events are associated with significant morbidity for the involved patients. Despite efforts by leading professional organizations such as the ACS, the rate of retained objects has remained stable.
The authors chose the interval between reported retained object events as the index of frequency; they formed a multidisciplinary team to design a multifactor quality improvement initiative including focused quiet time, minimizing interruptions, and closed loop communication during the final surgical count. The initiative was carried out in a single children’s healthcare system. The baseline interval between events was 29 days. After 2 years of improvement cycles, the interval had increased to 451 days. Adherence to the QI protocol was 96.4%.
They concluded that after obtaining buy-in from all participants, the quality improvement initiative was effective.
In the accompanying editorial, Mehul V. Raval, MD, FACS, noted that availability of technology such as RFID chips implanted in sponges, towels, and instruments would further improve these results. Although use of such technology comes with a financial cost, the return on investment could potentially be significant.
Rates of Morbidity and Mortality Associated with Esophageal Perforation Remain Unchanged since 2005
Wong LY, Leipzig M, Liou DZ, et al. Surgical Management of Esophageal Perforation: Examining Trends in a Multi-Institutional Cohort. J Gastrointest Surg. 2023;27(9): 1757-1765.
The study reported in this article reviewed data from the ACS National Surgical Quality Improvement Program database during three eras—2005 to 2009, 2010 to 2014, and 2015 to 2020—to determine changes in mortality and morbidity associated with esophageal perforation, as well as the effects of newer treatment approaches on outcomes.
The study cohort consisted of 378 patients; the main treatment method used was primary repair of the perforation (51%) followed by drainage (24%), resection (18%), and diversion (7%). Rates of primary repair increased during each of the studied intervals. Overall mortality was 9.5%, and the rate of complications was 71%.
When mortality and morbidity rates were examined for each of the chosen eras, there was no significant difference observed. Although primary repair was used more frequently in the latest era, possibly due to the increased usage of indwelling stents, outcomes remained similar.
The authors concluded that even though primary repair is used more frequently in current practice, mortality and morbidity rates for esophageal perforation are significant and have not changed during the 15-year interval of this study.
