Lustenberger Thomas, Meier Simon Lars, Verboket René Danilo, Störmann Philipp, Janko Maren, Frank Johannes, Marzi Ingo
Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University Frankfurt am Main, 60590 Frankfurt am Main, Germany.
J Clin Med. 2020 Dec 11;9(12):4006. doi: 10.3390/jcm9124006.
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.
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.
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 ( = 40, 24.8% of all surgical complications), followed by screw malposition ( = 20, 12.4%), postoperative dislocations of arthroplasties ( = 18, 11.2%), and suboptimal fracture reduction ( = 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.
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.
手术并发症给患者和医院带来了沉重负担，近期文献对此的讨论日益增多。这项队列研究回顾了一级创伤中心与手术相关的并发症。分析了避免并发症护理包对手术并发症发生率的影响。
我们创伤科发生的所有并发症（手术和非手术）均使用标准化文件表格进行前瞻性记录，并在每周的创伤发病率和死亡率（M&M）会议上进行讨论和分析。手术并发症发生率通过年度手术例数计算得出。基于M&M会议的讨论，制定了包含五项措施的避免并发症护理包：（1）提高团队态势感知能力；（2）减少手术室工作人员流动并限制开门次数；（3）术前筛查感染源；（4）在感染并发症高风险解剖区域调整术前抗生素预防措施；（5）使用含碘粘贴手术巾。
在研究期间，手术例数稳步增加，从2015年的3587例增至2019年的3962例（增长了10.5%）。在这5年研究期内，手术并发症总发生率为0.8%。手术部位感染是最常见的并发症（40例，占所有手术并发症的24.8%），其次是螺钉位置不当（20例，12.4%）、人工关节置换术后脱位（18例，11.2%）和骨折复位欠佳（18例，11.2%）。实施避免并发症护理包后，手术并发症总发生率显著下降，从2016年的1.14%降至研究期2019年的0.56%，即在3年时间内降低了51%。
基于对不良手术结局的透明讨论，可以成功建立旨在降低手术并发症发生率的多模式策略。不同预防措施的组合在3年时间内使总体并发症发生率降低了一半。
