A Framework for Successful Adoption of Surgical Innovation

Esfahani, Mona Seyed; Khajehpour, S. Heydari; Roushan-Easton, Gelareh; Howell, Robert D

doi:10.1177/15533506221074612

Cited by 6 publications

(1 citation statement)

References 35 publications

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“…From 1362 citations, a total of 11 research articles were included [30][31][32][33][34][35][36][37][38][39][40] (online supplemental figure 2). Barriers and facilitators were mapped onto the four constructs of UTAUT model (online supplemental table 6).…”

Section: Scoping Review 2: What Are the Barriers And Facilitators To ...mentioning

confidence: 99%

Theory and evidence-base for a digital platform for the delivery of language tests during awake craniotomy and collaborative brain mapping

Veljanoski,

Ng,

Hill

et al. 2024

BMJ Surg Interv Health Technologies

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ObjectivesBuild the theoretical and evidence-base for a digital platform (map-OR) which delivers intraoperative language tests during awake craniotomy and facilitates collaborative sharing of brain mapping data.DesignMixed methodology study including two scoping reviews, international survey, synthesis of development guiding principles and a risk assessment using failure modes and effects analysis.SettingThe two scoping reviews examined the literature published in the English language. International survey was completed by members of awake craniotomy teams from 14 countries.Main outcome measuresScoping review 1: number of technologies described for language mapping during awake craniotomy. Scoping review 2: barriers and facilitators to adopting novel technology in surgery. International survey: degree of language mapping technology penetration into clinical practice.ResultsA total of 12 research articles describing 6 technologies were included. The technologies required a range of hardware components including portable devices, virtual reality headsets and large integrated multiscreen stacks. The facilitators and barriers of technology adoption in surgery were extracted from 11 studies and mapped onto the 4 Unified Theory of Acceptance and Use of Technology constructs. A total of 37 awake craniotomy teams from 14 countries completed the survey. Of the responses, 20 (54.1%) delivered their language tests digitally, 10 (27.0%) delivered tests using cards and 7 (18.9%) used a combination of both. The most commonly used devices were tablet computers (67.7%; n=21) and the most common software used was Microsoft PowerPoint (60.6%; n=20). Four key risks for the proposed digital platform were identified, the highest risk being a software and internet connectivity failure during surgery.ConclusionsThis work represents a rigorous and structured approach to the development of a digital platform for standardized intraoperative language testing during awake craniotomy and for collaborative sharing of brain mapping data.Trial registration numberScoping review protocol registrations in OSF registries (scoping review 1: osf.io/su9xm; scoping review 2: osf.io/x4wsc).

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Section: Scoping Review 2: What Are the Barriers And Facilitators To ...mentioning

confidence: 99%

Theory and evidence-base for a digital platform for the delivery of language tests during awake craniotomy and collaborative brain mapping

Veljanoski,

Ng,

Hill

et al. 2024

BMJ Surg Interv Health Technologies

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Variations in Current Practice and Protocols of Intraoperative Multimodal Analgesia: A Cross-Sectional Study Within a Six-Hospital US Health Care System

Graham,

Illarmo,

Wren

et al. 2024

Anesthesia &Amp; Analgesia

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BACKGROUND: Multimodal analgesia (MMA) aims to reduce surgery-related opioid needs by adding nonopioid pain medications in postoperative pain management. In light of the opioid epidemic, MMA use has increased rapidly over the past decade. We hypothesize that the rapid adoption of MMA has resulted in variation in practice. This cross-sectional study aimed to determine how MMA practices have changed over the past 6 years and whether there is variation in use by patient, provider, and facility characteristics. METHODS: Our study population includes all patients undergoing surgery with general anesthesia at 1 of 6 geographically similar hospitals in the United States between January 1, 2017 and December 31, 2022. Intraoperative pain medications were obtained from the hospital’s perioperative information management system. MMA was defined as an opioid plus at least 2 other nonopioid analgesics. Frequencies, χ2 tests (χ2), range, and interquartile range (IQR) were used to describe variation in MMA practice over time, by patient and procedure characteristics, across hospitals, and across anesthesiologists. Multivariable logistic regression was conducted to understand the independent contributions of patient and procedural factors to MMA use. RESULTS: We identified 25,386 procedures among 21,227 patients. Overall, 46.9% of cases met our definition of MMA. Patients who received MMA were more likely to be younger females with a lower comorbidity burden undergoing longer and more complex procedures that included an inpatient admission. MMA use has increased steadily by an average of 3.0% each year since 2017 (95% confidence interval =2.6%–3.3%). There was significant variation in use across hospitals (n = 6, range =25.9%–68.6%, χ2 = 3774.9, P < .001) and anesthesiologists (n = 190, IQR =29.8%–65.8%, χ2 = 1938.5, P < .001), as well as by procedure characteristics. The most common MMA protocols contained acetaminophen plus regional anesthesia (13.0% of protocols) or acetaminophen plus dexamethasone (12.2% of protocols). During the study period, the use of opioids during the preoperative or intraoperative period decreased from 91.4% to 86.0% of cases; acetaminophen use increased (41.9%–70.5%, P < .001); dexamethasone use increased (24.0%–36.1%, P < .001) and nonsteroidal anti-inflammatory drugs (NSAIDs) increased (6.9%–17.3%, P < .001). Gabapentinoids and IV lidocaine were less frequently used but also increased (0.8%–1.6% and 3.4%–5.3%, respectively, P < .001). CONCLUSIONS: In a large integrated US health care system, approximately 50% of noncardiac surgery patients received MMA. Still, there was wide variation in MMA use by patient and procedure characteristics and across hospitals and anesthesiologists. Our findings highlight a need for further research to understand the reasons for these variations and guide the safe and effective adoption of MMA into routine practice.

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Advancements in Minimally Invasive Surgical Techniques: A Comprehensive Review

Pérez Ayme,

Caiza Suárez,

Paredes Ortega

et al. 2024

Salud, Ciencia y Tecnología

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Introduction: Minimally Invasive Surgical (MIS) techniques have revolutionized the field of surgery, offering significant benefits over traditional open surgery. This narrative review examines the historical evolution, current advancements, and prospects of MIS, with a focus on its impact on patient outcomes, surgical training, and healthcare systems. Objective: To provide a comprehensive overview of the advancements in MIS, highlighting technological innovations, changes in clinical practice, and the evolution of surgical education. The review also aims to discuss the challenges and future directions of MIS. Methods: The review included 24 articles published from 2004 to 2023. Criteria for inclusion were relevance to MIS development and impact, with exclusion for non-English and unrelated articles. Data were synthesized to outline the progression, current state, and future trends in MIS. Results: Key findings include significant advancements in surgical technologies such as robotics and enhanced imaging, the expansion of MIS across various specialties, and improved patient outcomes like reduced recovery times and lower complication rates. Challenges identified include the steep learning curve for surgeons and disparities in global access to MIS. Future trends indicate a move towards AI integration, personalized surgical approaches, and further refinement of robotic systems. Conclusions: MIS represents a paradigm shift in surgical practice, characterized by technological innovation and improved patient care. Despite challenges, its future is promising, with continuous advancements expected to further reshape surgical procedures.

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A Framework for Successful Adoption of Surgical Innovation

Cited by 6 publications

References 35 publications

Theory and evidence-base for a digital platform for the delivery of language tests during awake craniotomy and collaborative brain mapping

Theory and evidence-base for a digital platform for the delivery of language tests during awake craniotomy and collaborative brain mapping

Variations in Current Practice and Protocols of Intraoperative Multimodal Analgesia: A Cross-Sectional Study Within a Six-Hospital US Health Care System

Advancements in Minimally Invasive Surgical Techniques: A Comprehensive Review

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