Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
International Centre for Surgical Safety, Keenan Research Institute, St Michael's Hospital, Toronto, Ontario, Canada.
Br J Surg. 2018 Jul;105(8):1044-1050. doi: 10.1002/bjs.10811. Epub 2018 Mar 30.
The operating theatre is a unique environment with complex team interactions, where technical and non-technical performance affect patient outcomes. The correlation between technical and non-technical performance, however, remains underinvestigated. The purpose of this study was to explore these interactions in the operating theatre.
A prospective single-centre observational study was conducted at a tertiary academic medical centre. One surgeon and three fellows participated as main operators. All patients who underwent a laparoscopic Roux-en-Y gastric bypass and had the procedures captured using the Operating Room Black Box platform were included. Technical assessment was performed using the Objective Structured Assessment of Technical Skills and Generic Error Rating Tool instruments. For non-technical assessment, the Non-Technical Skills for Surgeons (NOTSS) and Scrub Practitioners' List of Intraoperative Non-Technical Skills (SPLINTS) tools were used. Spearman rank-order correlation and N-gram statistics were conducted.
Fifty-six patients were included in the study and 90 procedural steps (gastrojejunostomy and jejunojejunostomy) were analysed. There was a moderate to strong correlation between technical adverse events (r = 0·417-0·687), rectifications (r = 0·380-0·768) and non-technical performance of the surgical and nursing teams (NOTSS and SPLINTS). N-gram statistics showed that after technical errors, events and prior rectifications, the staff surgeon and the scrub nurse exhibited the most positive non-technical behaviours, irrespective of operator (staff surgeon or fellow).
This study demonstrated that technical and non-technical performances are related, on both an individual and a team level. Valuable data can be obtained around intraoperative errors, events and rectifications.
手术室是一个具有复杂团队互动的独特环境，技术和非技术性能都会影响患者的结局。然而，技术和非技术性能之间的相关性仍未得到充分研究。本研究旨在探索手术室中的这些相互作用。
在一家三级学术医疗中心进行了前瞻性单中心观察性研究。一名外科医生和三名研究员作为主要操作人员参与。所有接受腹腔镜 Roux-en-Y 胃旁路术且手术过程被手术室黑盒平台捕获的患者均被纳入研究。技术评估使用客观结构化评估技术技能和通用错误评分工具进行。对于非技术评估，使用外科医生非技术技能（NOTSS）和刷手护士术中非技术技能清单（SPLINTS）工具。进行 Spearman 秩相关和 N-gram 统计分析。
研究纳入了 56 名患者，分析了 90 个手术步骤（胃空肠吻合术和空肠空肠吻合术）。技术不良事件（r = 0.417-0.687）、纠正措施（r = 0.380-0.768）与手术和护理团队的非技术表现（NOTSS 和 SPLINTS）之间存在中度至高度相关性。N-gram 统计显示，在技术错误、事件和之前的纠正措施之后，主治外科医生和刷手护士表现出最积极的非技术行为，而与操作人员（主治外科医生或研究员）无关。
本研究表明，技术和非技术性能在个体和团队层面上是相关的。可以围绕术中错误、事件和纠正措施获得有价值的数据。
