A checklist for endonasal transsphenoidal anterior skull base surgery

Abstract

obJective Approximately 250 million surgical procedures are performed annually worldwide, and data suggest that major complications occur in 3%-17% of them. Many of these complications can be classified as avoidable, and previous studies have demonstrated that preoperative checklists improve operating room teamwork and decrease complication rates. Although the authors' institution has instituted a general preoperative "time-out" designed to streamline communication, flatten vertical authority gradients, and decrease procedural errors, there is no specific checklist for transnasal transsphenoidal anterior skull base surgery, with or without endoscopy. Such minimally invasive cranial surgery uses a completely different conceptual approach, set-up, instrumentation, and operative procedure. Therefore, it can be associated with different types of complications as compared with open cranial surgery. The authors hypothesized that a detailed, procedure-specific, preoperative checklist would be useful to reduce errors, improve outcomes, decrease delays, and maximize both teambuilding and operational efficiency. Thus, the object of this study was to develop such a checklist for endonasal transsphenoidal anterior skull base surgery. methods An expert panel was convened that consisted of all members of the typical surgical team for transsphenoidal endoscopic cases: neurosurgeons, anesthesiologists, circulating nurses, scrub technicians, surgical operations managers, and technical assistants. Beginning with a general checklist, procedure-specific items were added and categorized into 4 pauses: Anesthesia Pause, Surgical Pause, Equipment Pause, and Closure Pause. results The final endonasal transsphenoidal anterior skull base surgery checklist is composed of the following 4 pauses. The Anesthesia Pause consists of patient identification, diagnosis, pertinent laboratory studies, medications, surgical preparation, patient positioning, intravenous/arterial access, fluid management, monitoring, and other special considerations (e.g., Valsalva, jugular compression, lumbar drain, and so on). The Surgical Pause is composed of personnel introductions, planned procedural elements, estimation of duration of surgery, anticipated blood loss and fluid management, imaging, specimen collection, and questions of a surgical nature. The Equipment Pause assures proper function and availability of the microscope, endoscope, cameras and recorders, guidance systems, special instruments, ultrasonic microdoppler, microdebrider, drills, and other adjunctive supplies (e.g., Avitene, cotton balls, nasal packs, and so on). The Closure Pause is dedicated to issues of immediate postoperative patient disposition, orders, and management. coNclusioNs Surgical complications are a considerable cause of death and disability worldwide. Checklists have been shown to be an effective tool for reducing preventable errors surrounding surgery and decreasing associated complications. Although general checklists are already in place in most institutions, a specific chec...

Perioperative management in endoscopic endonasal skull‐base surgery: a survey of the North American Skull Base Society

“…In terms of preoperative practices, while most practitioners used preoperative IV antibiotics and prepared for intraoperative bleeding with at least a type and screen, there was significant variation in most other practice parameters. Only 1 in 3 and 1 in 4 of participants reported never using intranasal or facial preparation prior to surgery, respectively, despite the lack of any evidence in support of their use for prevention of postoperative infections and their lack of inclusion in previously published surgical checklists for endoscopic anterior cranial base surgery . Approximately 1 in 3 of respondents do not employ any head of bed elevation, although there is evidence from a double‐blind randomized controlled trial that a 20‐degree elevation of the head may improve visualization of the surgical field and decrease blood loss in endoscopic endonasal surgery .…”

“ABCDEF Checklist" based on 3D radiological images for preoperative planning of endoscopic sinus surgery

“…The finding of failed surgeries and the persistence and recurrence of sinonasal diseases after ESS due to causes attributable to the surgeon (19,20) , repeatedly raises the need for support toward the radiological location of anatomical landmarks and their inter-relations oriented to the preoperative planning of surgery, despite knowledge of the advantages of navigation during image-guided surgery (21) . Checklists based on the standardization and systematization of the evaluation by radiological images in 2D have translated into a reduction of complications in between 8% and 19% of the neurosurgical approaches (22) , and an improvement of 36% in the rate of foreseeable failures associated with the ESS treatment of the sellar region and the skull base (23,24) . Even so, checklists have not prevented ESS from unsatisfactory outcomes, such surgeries constituting one of the main sources of legal demands in otolaryngology (25,26) .…”

Modified surgical safety checklist (mSSC)- a must to avoid disaster in neurosurgical procedures!

“…10 Using such a checklist is a proven method of avoiding surgical complication, a major cause of death and disability worldwide. 6,10,11,12,13 However in neurosurgical OR such SSC are still lacking and almost none in developing countries like ours. 14 Written specifi cations with regard to procedures performed, equipment used, and training of the involved personnel are widely used in the industry and aviation to guarantee constant quality.…”

“…6,26,27 Procedure specifi c or technology tailored SSC have been designed incorporating specifi c steps of surgery to ensure safety of patient. 6,24,25 Successful implementation requires peri-operative stakeholders to understand the nature of errors, recognize the complex dynamic between systems and individuals, and create a just culture that encourages a shared vision of patient safety.…”

“…1,2,3,4,5 Loco regional variation in conceptual approach, set up, instrumentation and operative procedure create lot of confusion in using a universal SSC. 6 Besides lack of technical knowledge and use of not-for-purpose instruments during surgery demand good communication between team members. Hence we designed a modifi ed version of WHO SSC which suits our demands and is easy to administer.…”