Department of Plastic, Aesthetic and Hand Surgery, AMEOS Hospital Halberstadt, Germany.
Department of Plastic, Aesthetic and Hand Surgery, AMEOS Hospital Halberstadt, Germany; Institute for Biometrics and Medical Informatics, Otto von Guericke University Magdeburg, Germany.
Surgeon. 2019 Aug;17(4):233-243. doi: 10.1016/j.surge.2018.07.001. Epub 2018 Aug 7.
Non-technical skills (NTS) failures have been implicated in a large proportion of surgical errors. The objective of this meta-analysis was to investigate whether NTS training of theatre staff improves patient outcomes.
In a systematic literature search all interventional studies evaluating the effects of NTS training of theatre staff were identified. Primary outcomes included mortality, morbidity, readmission rate and length of hospital stay. Secondary outcomes included staff NTS, checklist use and technical surgical performance. Pooled odds ratios (OR) were determined for event rates and weighted mean differences (WMD) for continuous data. An inverse variance method in a random effects model was used for meta-analysis.
A total of 1381 records were identified and nine studies were included. Meta-analysis of mortality was not carried out because only two controlled studies with different study designs were identified. No statistically significant differences were seen in complication rate (5 studies, OR 0.91 [0.73, 1.14]; p = 0.43), readmission rate (3 studies, OR 0.90 [0.63, 1.28], p = 0.56) and length of hospital stay (3 studies, WMD -0.88 days [-2.06, 0.31], p = 0.31) after NTS training. Of the secondary outcomes, an improvement of whole team NOTECHS II scores was observed in the intervention group (3 studies, WMD 6.97 [3.88, 10.06], p < 0.0001). Technical performance and checklist use were unchanged.
This meta-analysis failed to find a statistically significant improvement of patient outcomes. These conclusions are based on a small number of heterogeneous studies. Further appropriately powered studies are likely to improve our understanding of the effects of NTS training.
非技术技能（NTS）故障在很大比例的手术错误中都有牵连。本荟萃分析的目的是调查手术室工作人员的 NTS 培训是否能改善患者的结局。
在系统文献检索中，确定了所有评估手术室工作人员 NTS 培训效果的干预性研究。主要结局包括死亡率、发病率、再入院率和住院时间。次要结局包括工作人员 NTS、检查表使用和技术手术表现。事件发生率的汇总优势比（OR）和连续数据的加权均数差（WMD）。使用随机效应模型的逆方差法进行荟萃分析。
共确定了 1381 条记录，纳入了 9 项研究。由于只确定了两项具有不同研究设计的对照研究，因此未进行死亡率的荟萃分析。在并发症发生率（5 项研究，OR 0.91[0.73，1.14]；p=0.43）、再入院率（3 项研究，OR 0.90[0.63，1.28]；p=0.56）和住院时间（3 项研究，WMD-0.88 天[-2.06，0.31]；p=0.31）方面，NTS 培训后未见统计学差异。在次要结局中，干预组观察到整个团队 NOTECHS II 评分的提高（3 项研究，WMD 6.97[3.88，10.06]；p<0.0001）。技术表现和检查表使用没有改变。
本荟萃分析未发现患者结局有统计学意义的改善。这些结论基于少数异质性研究。进一步进行适当的、有影响力的研究可能会增进我们对 NTS 培训效果的理解。
