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Surgical Performance (surgical + performance)
Selected AbstractsMonitoring surgical performance: an application to total hip replacementJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2009David J. Biau MD Abstract Rationale, aims and objectives, Inadequate surgical implantation of a hip replacement may result in decreased patient satisfaction and reduced implant survival. The objective was to monitor surgical performance in hip replacement. Method, The study took place at a teaching centre. All primary total hip replacements were prospectively included in the series. For each hip replacement, intraoperative technical errors, cup and stem fixation and position, and postoperative complications were recorded. If all items rated were correct, the procedure was considered as correct. The Cumulative Sums (CUSUM) test was used to monitor the performance of the centre. A 90% proportion of successful procedures was considered as adequate performance and a 75% proportion of successful procedures was deemed as inadequate performance. Meetings were conducted to discuss the results of monitoring. Results, Eighty-three total hip replacements were monitored. Overall, 28 procedures (34%) were considered inadequate. The most potent reasons for inadequate performance were cup positioning and stem fixation. The CUSUM test signalled after the second procedure that performance was inadequate. After the first meeting, despite an improvement was seen, the CUSUM test raised an alarm indicating inadequate performance. The study was stopped after the second meeting because of funding reasons before it could be demonstrated that performance had reached the desired level. Conclusion, This study has demonstrated that implementing a dedicated system to monitor surgical performance in a teaching hospital improves the quality of implantation of total hip replacements. Nonetheless, the target of ninety percent of adequate primary total hip replacement could not be reached and efforts should be continued. [source] Commissioned analysis of surgical performance using routine data: lessons from the Bristol inquiryJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES A (STATISTICS IN SOCIETY), Issue 2 2002David J. Spiegelhalter The public inquiry into paediatric cardiac surgery at the Bristol Royal Infirmary commissioned the authors to design and conduct analyses of routine data sources to compare surgical outcomes between centres. Such analyses are necessarily complex in this context but were further hampered by the inherent inconsistencies and mediocre quality of the various sources of data. Three levels of analysis of increasing sophistication were carried out. The reasonable consistency of the results arising from different sources of data, together with a number of sensitivity analyses, led us to conclude that there had been excess mortality in Bristol in open heart operations on children under 1 year of age. We consider criticisms of our analysis and discuss the role of statisticians in this inquiry and their contribution to the final report of the inquiry. The potential statistical role in future programmes for monitoring clinical performance is highlighted. [source] Efficacy of preoperative gonadotropin-releasing hormone agonist therapy for laparoscopic myomectomyASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 1 2009Y Kotani Abstract Objective: In this article, we evaluate efficacy of preoperative gonadotropin-releasing hormone agonist (GnRHa) therapy prior to laparoscopic myomectomy (LM). Materials and Methods: There were 161 subjects who underwent LM between 1995 and 2007. They were divided into two groups: group A (58 cases), who underwent four to six cycles of preoperative GnRHa therapy, and group B (103 cases), the untreated group. To determine the efficacy of preoperative GnRHa therapy, the recurrence rate after LM was evaluated by comparing the number of myoma confirmed on the preoperative MRI and the number actually enucleated. For this purpose, the cases were divided into the matched group (group I) and the discrepancy group (group II) whose enucleated number was smaller than the estimated number. Results: No statistically significant difference was observed between groups A and B in the surgical performance. The 4 year cumulative recurrence rate was estimated to be 27.3% for group A and 25.8% for group B without any significant difference. In group A, the postoperative recurrence rate was statistically significantly higher in group II (44.4%) than in group I (12.1%). While in group I, it was 12.1% in group A and 14.3% in group B without a statistically significant difference. Discussion: Preoperative GnRHa therapy did not compromise surgical outcome or recurrence rate, rather it acted as an effective pretreatment for LM in terms of expanding its indications. Also, completing surgery by enucleating all the myomas without any left in situ, as confirmed by the precise preoperative myoma status on the MRI, contributes to a reduction in the postoperative recurrence rate. [source] Standards for the management of cervical and vulval carcinomaBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 7 2000Thomas J. D'Arcy Trainee (Gynaecological Oncology) Objective To examine the feasibility of achieving designated target standards for the management of women with cervical and vulval cancer. Design Retrospective casenote review. Setting The Gynaecological Oncology Centre at Hammersmith Hospital, London. Population Sixty-one women with cervical and vulval cancer presenting to the gynaecological oncology clinic at the Hammersmith Hospital during 1996 and 1997. Various aspects of the management of those women were compared with standards suggested by a multidisciplinary panel of local experts. Targets included the referral and treatment process, the accuracy of staging, and measures of surgical performance. Results The target interval of seven days between receipt of the referral and the first visit at the cancer centre was achieved in 93% of women. Surgical treatment was administered to 92% of the women within the target of 20 working days from the first clinic appointment. Tumour close to or involving the margins of the specimen was noted in 13% of cervical and 9% of vulval cancers. The node count fell below the target standards in 13% of pelvic and 10% of groin dissections. Appropriate imaging investigations for staging were not undertaken in 15 of 39 cases (38%) of cervical cancer and in 5 out of 22 (23%) of vulval cancers. Conclusion The suggested targets of process and surgical performance are reasonable and achievable. These standards would be appropriate for national use. The area most clearly identified where these targets were not achieved was the requesting of complementary staging investigations. This could be addressed by the use of a simple investigation protocol to be included in each patient's notes and available at specialist clinics and gynaecology wards. [source] The long learning curve of gynaecological cancer surgery: an argument for centralisationBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 1 2000J. Baptist Trimbos Professor Objective To study the development of surgical performance of an unchanging surgical team over 13 years. Design Prospective, observational study. Setting A university hospital, The Netherlands. Participants Three hundred and eight women who underwent surgical treatment for early cervical cancer. Interventions Radical hysterectomy and pelvic lymphadenectomy between 1 January 1984 and 31 December 1996. Results The surgical procedure and indication for treatment remained unchanged during the study period. This applied also to the surgical team. The women's age increased significantly during the study years, as was the case with the number of nodes removed. The depth of infiltration by the tumour increased steadily throughout the study, but this failed to reach statistical significance. The distribution of FIGO stages, percentage of positive lymph nodes, radicality of the surgical margins and post-operative morbidity remained the same. Overall, the five year survival rate was 83%; for women with negative nodes 91%, and for women with positive nodes 53%. Survival tended to improve during the course of the study, but this was not statistically significant. Blood loss during surgery decreased consistently during the whole study period, from a mean of 1515 mL at the beginning of the study to a mean of 1071 mL at the end (P < 0.0001). The operating time also diminished significantly by 8 minutes per year (P < 0.0001). In 1985 the average operating time was 270 minutes, compared with 187 minutes in 1996. Conclusions These findings indicate that it takes a long time to acquire skill in the surgical treatment of early cervical cancer. Centralisation of relatively infrequent operations for cancer should be encouraged. [source] | ||||||||||