Perioperative management of positioning in gynecological cancersurgery: a national NOGGO-AGO intergroup survey

Abstract

IntroductionThe daily clinical routine in the operating room includes patient positioning. The number of perioperative positioning-related complications is growing, along with the legal proceedings concerning this topic, and only a few guidelines exist to provide specific recommendations. The aim of this survey was to assess perioperative positioning and associated adverse events during gynecological cancer surgery in Germany.MethodsA total of 633 gynecological departments of primary, secondary, and maximum healthcare hospitals in Germany were invited to participate in this multiple-choice online questionnaire. The survey was conducted anonymously for a period of six months. The survey was divided into five different sections: descriptive information about the respondent department, pre- and postoperative management, management of positioning in the operating room based on two fictional case examples, and quality management.ResultsThe response rate of our survey was 29.1 % (184/633). Nearly half of the departments (46.7 %) reported to have had one to five patients with positioning-related complications during the prior 12 months, and 29.1 % had experienced a legal dispute due to positioning-related complications. Departments with more than 50 gynecologic-oncological surgeries per year more often reported positioning-related complications (p=0.003). Standard operating procedures exist in almost every department for laparoscopic (97 %) and open surgery (95.1 %), respectively.DiscussionThe high number of positioning-related complications throughout all departments of different healthcare levels underlines the relevance of this issue and supports the need for a prospective European registry for further analysis. Training and education for all staff members should be routinely implemented to reduce and prevent positioning-related complications.

Ovarialkarzinom: Perioperatives Management

“…Eine Umfrage unter deutschen gynäkologisch-onkologischen Chirurgen ergab, dass etwa die Hälfte der Befragten in der letzten 12 Monaten 1-5 Fälle lagerungsbedingter Komplikationen erlebt hatten. 29,1% berichteten von einem Rechtsstreit wegen Lagerungsschäden in diesem Zeitraum [23].…”

The Prevention of Positioning Injuries During Gynecologic Surgery. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/077, October 2020)

“…All persons involved have a legal obligation of due care. The goal must be to guarantee patient safety and prevent positioning injuries [1]. It is important to balance the surgeonʼs need for an optimal view of the operating site in every patient position and during any changes in positioning against the concerns of the anesthesiologist about maintaining the best and safest access to the patient.…”