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Multicentre observational study of surgical system failures in aortic procedures and their effect on patient outcomes

(2016) BRITISH JOURNAL OF SURGERY. 103(11). p.1467-1475
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Organization
Abstract
Background: Vascular surgical care has changed dramatically in recent years with little knowledge of the impact of system failures on patient safety. The primary aim of this multicentre observational study was to define the landscape of surgical system failures, errors and inefficiency (collectively termed failures) in aortic surgery. Secondary aims were to investigate determinants of these failures and their relationship with patient outcomes. Methods: Twenty vascular teams at ten English hospitals trained in structured self-reporting of intraoperative failures (phase I). Failures occurring in open and endovascular aortic procedures were reported in phase II. Failure details (category, delay, consequence), demographic information (patient, procedure, team experience) and outcomes were reported. Results: There were strong correlations between the trainer and teams for the number and type of failures recorded during 88 procedures in phase I. In 185 aortic procedures, teams reported a median of 3 (i.q.r. 2-6) failures per procedure. Most frequent failures related to equipment (unavailability, failure, configuration, desterilization). Most major failures related to communication. Fourteen failures directly harmed 12 patients. Significant predictors of an increased failure rate were: endovascular compared with open repair (incidence rate ratio (IRR) for open repair 071, 95 per cent c.i. 057 to 088; P=0002), thoracic aneurysms compared with other aortic pathologies (IRR 207, 139 to 308; P<0001) and unfamiliarity with equipment (IRR 152, 120 to 191; P<0001). The major failure total was associated with reoperation (P=0011), major complications (P=0029) and death (P=0027). Conclusion: Failure in aortic procedures is frequently caused by issues with team-working and equipment, and is associated with patient harm. Multidisciplinary team training, effective use of technology and new-device accreditation may improve patient outcomes.
Keywords
ADVERSE EVENTS, MORTALITY

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MLA
Lear, R., et al. “Multicentre Observational Study of Surgical System Failures in Aortic Procedures and Their Effect on Patient Outcomes.” BRITISH JOURNAL OF SURGERY, vol. 103, no. 11, 2016, pp. 1467–75.
APA
Lear, R., Riga, C., Godfrey, A., Falaschetti, E., Cheshire, N., Van Herzeele, I., … Bicknell, C. (2016). Multicentre observational study of surgical system failures in aortic procedures and their effect on patient outcomes. BRITISH JOURNAL OF SURGERY, 103(11), 1467–1475.
Chicago author-date
Lear, R, C Riga, AD Godfrey, E Falaschetti, NJ Cheshire, Isabelle Van Herzeele, C Norton, C Vincent, AW Darzi, and CD Bicknell. 2016. “Multicentre Observational Study of Surgical System Failures in Aortic Procedures and Their Effect on Patient Outcomes.” BRITISH JOURNAL OF SURGERY 103 (11): 1467–75.
Chicago author-date (all authors)
Lear, R, C Riga, AD Godfrey, E Falaschetti, NJ Cheshire, Isabelle Van Herzeele, C Norton, C Vincent, AW Darzi, and CD Bicknell. 2016. “Multicentre Observational Study of Surgical System Failures in Aortic Procedures and Their Effect on Patient Outcomes.” BRITISH JOURNAL OF SURGERY 103 (11): 1467–1475.
Vancouver
1.
Lear R, Riga C, Godfrey A, Falaschetti E, Cheshire N, Van Herzeele I, et al. Multicentre observational study of surgical system failures in aortic procedures and their effect on patient outcomes. BRITISH JOURNAL OF SURGERY. 2016;103(11):1467–75.
IEEE
[1]
R. Lear et al., “Multicentre observational study of surgical system failures in aortic procedures and their effect on patient outcomes,” BRITISH JOURNAL OF SURGERY, vol. 103, no. 11, pp. 1467–1475, 2016.
@article{8655779,
  abstract     = {{Background: Vascular surgical care has changed dramatically in recent years with little knowledge of the impact of system failures on patient safety. The primary aim of this multicentre observational study was to define the landscape of surgical system failures, errors and inefficiency (collectively termed failures) in aortic surgery. Secondary aims were to investigate determinants of these failures and their relationship with patient outcomes. 
Methods: Twenty vascular teams at ten English hospitals trained in structured self-reporting of intraoperative failures (phase I). Failures occurring in open and endovascular aortic procedures were reported in phase II. Failure details (category, delay, consequence), demographic information (patient, procedure, team experience) and outcomes were reported. 
Results: There were strong correlations between the trainer and teams for the number and type of failures recorded during 88 procedures in phase I. In 185 aortic procedures, teams reported a median of 3 (i.q.r. 2-6) failures per procedure. Most frequent failures related to equipment (unavailability, failure, configuration, desterilization). Most major failures related to communication. Fourteen failures directly harmed 12 patients. Significant predictors of an increased failure rate were: endovascular compared with open repair (incidence rate ratio (IRR) for open repair 071, 95 per cent c.i. 057 to 088; P=0002), thoracic aneurysms compared with other aortic pathologies (IRR 207, 139 to 308; P<0001) and unfamiliarity with equipment (IRR 152, 120 to 191; P<0001). The major failure total was associated with reoperation (P=0011), major complications (P=0029) and death (P=0027). 
Conclusion: Failure in aortic procedures is frequently caused by issues with team-working and equipment, and is associated with patient harm. Multidisciplinary team training, effective use of technology and new-device accreditation may improve patient outcomes.}},
  author       = {{Lear, R and Riga, C and Godfrey, AD and Falaschetti, E and Cheshire, NJ and Van Herzeele, Isabelle and Norton, C and Vincent, C and Darzi, AW and Bicknell, CD}},
  issn         = {{0007-1323}},
  journal      = {{BRITISH JOURNAL OF SURGERY}},
  keywords     = {{ADVERSE EVENTS,MORTALITY}},
  language     = {{eng}},
  number       = {{11}},
  pages        = {{1467--1475}},
  title        = {{Multicentre observational study of surgical system failures in aortic procedures and their effect on patient outcomes}},
  url          = {{http://dx.doi.org/10.1002/bjs.10275}},
  volume       = {{103}},
  year         = {{2016}},
}

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