Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA.
Neurosurg Focus. 2012 Nov;33(5):E1. doi: 10.3171/2012.9.FOCUS12184.
Neurosurgery is a high-risk specialty currently undertaking the pursuit of systematic approaches to reducing risk and to measuring and improving outcomes. The authors performed a review of patterns and frequencies of adverse events in neurosurgery as background for future efforts directed at the improvement of quality and safety in neurosurgery. They found 6 categories of contributory factors in neurosurgical adverse events, categorizing the events as influenced by issues in surgical technique, perioperative medical management, use of and adherence to protocols, preoperative optimization, technology, and communication. There was a wide distribution of reported occurrence rates for many of the adverse events, in part due to the absence of definitive literature in this area and to the lack of standardized reporting systems. On the basis of their analysis, the authors identified 5 priority recommendations for improving outcomes for neurosurgical patients at a population level: 1) development and implementation of a national registry for outcome data and monitoring; 2) full integration of the WHO Surgical Safety Checklist into the operating room workflow, which improves fundamental aspects of surgical care such as adherence to antibiotic protocols and communication within surgical teams; and 3-5) activity by neurosurgical societies to drive increased standardization for the safety of specialized equipment used by neurosurgeons (3), more widespread regionalization and/or subspecialization (4), and establishment of data-driven guidelines and protocols (5). The fraction of adverse events that might be avoided if proposed strategies to improve practice and decrease variability are fully adopted remains to be determined. The authors hope that this consolidation of what is currently known and practiced in neurosurgery, the application of relevant advances in other fields, and attention to proposed strategies will serve as a basis for informed and concerted efforts to improve outcomes and patient safety in neurosurgery.
神经外科学是一个高风险的专业领域，目前正在努力寻求系统性的方法来降低风险，并衡量和改善治疗效果。作者对神经外科不良事件的模式和频率进行了回顾，为未来改善神经外科学的质量和安全的努力提供了背景信息。他们发现神经外科不良事件有 6 类促成因素，将这些事件分为受手术技术、围手术期医疗管理、协议的使用和遵守、术前优化、技术和沟通等问题影响的类别。许多不良事件的报告发生率分布广泛，部分原因是该领域缺乏明确的文献资料，也缺乏标准化的报告系统。基于他们的分析，作者确定了 5 项改善神经外科患者整体治疗效果的优先建议：1）开发和实施用于结果数据和监测的国家注册系统；2）将世界卫生组织手术安全检查表全面纳入手术室工作流程，这可以改善手术护理的基本方面，如遵守抗生素协议和手术团队内的沟通；以及 3-5）神经外科学会采取行动，推动神经外科医生使用的专用设备的安全性的进一步标准化（3）、更广泛的区域化和/或专业化（4），以及建立基于数据的指南和协议（5）。如果充分采用这些改善实践和减少变异性的建议策略，可能会避免一部分不良事件。作者希望，对目前神经外科学中已知和实践的内容进行整合，应用其他领域的相关进展，并关注所提出的策略，将为改善神经外科学的结果和患者安全提供依据，并推动协调一致的努力。
