Clinical Evaluation of Intraoperative Near Misses in Laparoscopic Rectal Cancer Surgery

Abstract

Objective: To investigate the frequency, nature, and severity of intraoperative adverse near miss events within advanced laparoscopic surgery and report any associated clinical impact. Background: Despite implementation of surgical safety initiatives, the intraoperative period is poorly documented with evidence of underreporting. Near miss analyses are undertaken in high-risk industries but not in surgical practice. Methods: Case video and data from 2 laparoscopic total mesorectal excision randomized controlled trials were analyzed (ALaCaRT ACTRN12609000663257, 2D3D ISRCTN59485808). Intraoperative adverse events were identified and categorized using the observational clinical human reliability analysis technique. The EAES classification was applied by 2 blinded assessors. EAES grade 1 events (nonconsequential error, no damage, or need for correction) were considered near misses. Associated clinical impact was assessed with early morbidity and histopathology outcomes. Results: One hundred seventy-five cases contained 1113 error events. Six hundred ninety-eight (62.7%) were near misses (median 3, IQR 2–5, range 0–15) with excellent inter-rater and test–retest reliability (κ=0.86, 95% CI 0.83–0.89, P < 0.001 and κ=0.88, 95% CI 0.85–0.9, P < 0.001 respectively). Significantly more near misses were seen in patients who developed early complications (4 (3–6) vs. 3 (2–4), P < 0.001). Higher numbers of near misses were seen in patients with more numerous (P = 0.002) and more serious early complications (P = 0.003). Cases containing major intraoperative adverse events contained significantly more near misses (5 (3–7) vs. 3 (2–5), P < 0.001) with a major event observed for every 19.4 near misses. Conclusion: Intraoperative adverse events and near misses can be reliably and objectively captured in advanced laparoscopic surgery. Near misses are commonplace and closely associated with morbidity outcomes.

Supporting laparoscopic general surgery training with digital technology: The United Kingdom and Ireland paradigm

“…Patients with higher recorded rates of errors had more early postoperative complications. Cases with a significant intraoperative event demonstrated significantly greater number of 'near misses' , compared to cases without significant intraoperative events [49].…”

“…Surgical errors and poor technical skill in laparoscopic colorectal and UGI surgery are associated with an increased risk of postoperative mortality and morbidity [48][49][50]. Twenty bariatric surgeons from the United States of America (USA), each submitted a single representative laparoscopic gastric bypass video with clinical data for peer-peer assessment of technical skills.…”

“…One hundred and seventy-five unedited laparoscopic TaTME videos were analysed using Observational Clinical Human Reliability Analysis (OCHRA) [49]. Curtis et al argue inconsequential error, or 'near misses' are both prevalent and underreported with greater clinical significance.…”

Machine Learning and Learning Machines: KI in der Aus- und Weiterbildung

“…Empfehlungen wie Fehler vermieden werden können, bevor sie entstehen, sog. Predictive Analytics [14].…”

Classification strategies for non‐routine events occurring in high‐risk patient care settings: A scoping review

“…This open‐ended approach captures events that are workflow deviations from a pre‐defined best practice (eg, oesophageal intubation), unusual events that cause no harm (eg, provider tripping over wires), or events unrelated to care that create unsafe situations (eg, power outage) 1,3,5 . Most of these studies have found that errors directly causing harm are uncommon, but events that are latent safety threats are frequent and could be precursors to adverse events 1,5,8‐10 . Proper identification and analysis of NREs that represent latent safety threats may facilitate the development of approaches for preventing or mitigating associated harm.…”