The Implementation of a Complication Avoidance Care Bundle Significantly Reduces Adverse Surgical Outcomes in Orthopedic Trauma Patients

Abstract

Background: Surgical complications are associated with a significant burden to patients and hospitals and are increasingly discussed in recent literature. This cohort study reviewed surgery-related complications in a Level I trauma center. The effect of a complication avoidance care bundle on the rate of surgical complications was analyzed. Methods: All complications (surgical and nonsurgical) that occur in our trauma department are prospectively captured using a standardized documentation form and are discussed and analyzed in a weekly trauma Morbidity and Mortality (M&M) conference. Surgical complication rates are calculated using the annual surgical procedure numbers. Based on discussions in the M&M conference, a complication avoidance care bundle consisting of five measures was established: (1) Improving team situational awareness; (2) reducing operating room traffic by staff members and limiting door-opening events; (3) preoperative screening for infectious foci; (4) adapted preoperative antibiotic prophylaxis in anatomic regions with a high risk of infectious complications; and (5) use of iodine-impregnated adhesive drape. Results: The number of surgical procedures steadily increased over the study years, from 3587 in 2015 to 3962 in 2019 (an increase of 10.5%). Within this 5-year study period, the overall rate of surgical complications was 0.8%. Surgical site infections were the most frequently found complications (n = 40, 24.8% of all surgical complications), followed by screw malposition (n = 20, 12.4%), postoperative dislocations of arthroplasties (n = 18, 11.2%), and suboptimal fracture reduction (n = 18, 11.2%). Following implementation of the complication avoidance care bundle, the overall rate of surgical complications significantly decreased, from 1.14% in the year 2016 to 0.56% in the study year 2019, which represents a reduction of 51% within a 3-year time period. Conclusions: A multimodal strategy targeted at reducing the surgical complication rate can be successfully established based on a transparent discussion of adverse surgical outcomes. The combination of the different preventive measures was associated with reducing the overall complication rate by half within a 3-year time period.

What to expect? Injury patterns of Electric-Scooter accidents over a period of one year - A prospective monocentric study at a Level 1 Trauma Center

“…Abdominal injuries were not detected in any of the cases. This was also observed in other studies on E-scooter accidents [ 2 , 8 , 9 ]. Nevertheless, abdominal types of injury should always be considered, since handlebar impact into the abdomen, similar to bicycle riders, often cannot be excluded with certainty.…”

“…In 47.4% of cases, upper limb injuries and in 36.8% lower limb injuries were found. Head injuries occurred in 38.16% of cases [ 2 ]. This constellation is also reflected in our statistics with a slightly different weighting, thus underlining the hypothesis that such injuries are mostly to be expected in E-scooter-related accidents (Table 2 ).…”

“…This was also described in the above-mentioned study from Frankfurt. In 32.9% of the cases, trauma occurred during the first use of an E-scooter [ 2 ]. However, as far as our study is concerned, data on this aspect have not been collected and are therefore merely an assumption.…”

“…Initial studies on injury patterns have already been published in many countries [ 2 – 6 ]. Injuries to the face and extremities account for the majority of these injuries.…”

“…Injuries to the face and extremities account for the majority of these injuries. Most of accidents occur outside regular working hours, especially over the weekend, which places an additional burden on the emergency capacities of medical facilities [ 2 ].…”