Division of General Surgery, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.
Br J Surg. 2013 Jul;100(8):1080-8. doi: 10.1002/bjs.9168.
Surgical error analysis is essential for investigating mechanisms of errors, events and adverse outcomes. Furthermore, it provides valuable information for formative feedback and quality control. The aim of the present study was to design and validate a technical error rating tool in laparoscopic surgery.
The framework consisted of nine task groups and four error modes. Unedited videos of laparoscopic Roux-en-Y gastric bypass procedures were rated and analysed. The Objective Structured Assessment of Technical Skill (OSATS) global rating scale was used to assess technical skills. The incidence of errors and of injuries (events) were the main outcome measures, and were used to calculate the reliability, and construct and concurrent validity of the instrument.
Two observers analysed 25 procedures. Inter-rater reliability was high regarding total number of errors (intraclass correlation coefficient (ICC) 0·90) and events (ICC 0·85). The median (interquartile range) error rate was 35 (26-44) and the event rate 3 (2-3) per procedure. Error frequencies and OSATS scores correlated significantly in all operative steps (rs = -0·75 to -0·40, P = <0·001-0·046). Surgeons demonstrating high OSATS scores had lower median (i.q.r.) error rates than surgeons with low scores in three of four steps: measuring bowel (4 (2-7) versus 10 (9-11); P = 0·004), jejunojejunostomy formation (5 (2-6) versus 10 (9-11); P = 0·001) and pouch formation (4 (3-6) versus 9 (5-12); P = 0·004).
The proposed error rating tool allows an objective and reliable assessment of operative performance in laparoscopic gastric bypass procedures.
手术错误分析对于研究错误、事件和不良后果的机制至关重要。此外，它还为形成性反馈和质量控制提供了有价值的信息。本研究旨在设计和验证腹腔镜手术中的技术错误评分工具。
该框架由九个任务组和四个错误模式组成。对腹腔镜 Roux-en-Y 胃旁路手术的未编辑视频进行评分和分析。使用客观结构化手术技能评估（OSATS）总体评分量表评估技术技能。错误和损伤（事件）的发生率是主要的观察结果，并用于计算工具的可靠性、构建和同时有效性。
两名观察者分析了 25 例手术。总错误数（组内相关系数（ICC）0.90）和事件（ICC 0.85）的观察者间可信度较高。每例手术的平均（四分位间距）错误率为 35（26-44），事件率为 3（2-3）。所有手术步骤的错误频率与 OSATS 评分均呈显著相关（rs=-0.75 至-0.40，P<0.001-0.046）。在四个步骤中的三个步骤中，OSATS 评分高的外科医生的平均（四分位间距）错误率低于评分低的外科医生：测量肠（4（2-7）与 10（9-11）；P=0.004）、空肠空肠吻合术形成（5（2-6）与 10（9-11）；P=0.001）和袋形成（4（3-6）与 9（5-12）；P=0.004）。
所提出的错误评分工具可用于客观、可靠地评估腹腔镜胃旁路手术中的手术表现。
