Mass General Brigham, Harvard Medical School, Boston, Massachusetts.
Department of Psychology, Roanoke College, Salem, Virginia.
JAMA Netw Open. 2024 Jul 1;7(7):e2422520. doi: 10.1001/jamanetworkopen.2024.22520.
Assessing nontechnical skills in operating rooms (ORs) is crucial for enhancing surgical performance and patient safety. However, automated and real-time evaluation of these skills remains challenging.
To explore the feasibility of using motion features extracted from surgical video recordings to automatically assess nontechnical skills during cardiac surgical procedures.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used video recordings of cardiac surgical procedures at a tertiary academic US hospital collected from January 2021 through May 2022. The OpenPose library was used to analyze videos to extract body pose estimations of team members and compute various team motion features. The Non-Technical Skills for Surgeons (NOTSS) assessment tool was employed for rating the OR team's nontechnical skills by 3 expert raters.
NOTSS overall score, with motion features extracted from surgical videos as measures.
A total of 30 complete cardiac surgery procedures were included: 26 (86.6%) were on-pump coronary artery bypass graft procedures and 4 (13.4%) were aortic valve replacement or repair procedures. All patients were male, and the mean (SD) age was 72 (6.3) years. All surgical teams were composed of 4 key roles (attending surgeon, attending anesthesiologist, primary perfusionist, and scrub nurse) with additional supporting roles. NOTSS scores correlated significantly with trajectory (r = 0.51, P = .005), acceleration (r = 0.48, P = .008), and entropy (r = -0.52, P = .004) of team displacement. Multiple linear regression, adjusted for patient factors, showed average team trajectory (adjusted R2 = 0.335; coefficient, 10.51 [95% CI, 8.81-12.21]; P = .004) and team displacement entropy (adjusted R2 = 0.304; coefficient, -12.64 [95% CI, -20.54 to -4.74]; P = .003) were associated with NOTSS scores.
This study suggests a significant link between OR team movements and nontechnical skills ratings by NOTSS during cardiac surgical procedures, suggesting automated surgical video analysis could enhance nontechnical skills assessment. Further investigation across different hospitals and specialties is necessary to validate these findings.
评估手术室（OR）中的非技术技能对于提高手术表现和患者安全至关重要。然而，这些技能的自动化和实时评估仍然具有挑战性。
探索使用从手术录像中提取的运动特征自动评估心脏手术过程中非技术技能的可行性。
设计、设置和参与者：本横断面研究使用了 2021 年 1 月至 2022 年 5 月期间在美国一家三级学术医院收集的心脏手术录像。使用 OpenPose 库分析视频以提取团队成员的身体姿势估计值，并计算各种团队运动特征。使用非技术技能评估工具（NOTSS）由 3 名专家评估者对 OR 团队的非技术技能进行评分。
NOTSS 总分，以手术录像中提取的运动特征作为衡量标准。
共纳入 30 例完整的心脏手术：26 例（86.6%）为体外循环冠状动脉旁路移植术，4 例（13.4%）为主动脉瓣置换或修复术。所有患者均为男性，平均（SD）年龄为 72（6.3）岁。所有手术团队均由 4 个关键角色（主治外科医生、主治麻醉师、主要灌注师和洗手护士）组成，并辅以额外的辅助角色。NOTSS 评分与团队位移的轨迹（r=0.51，P=0.005）、加速度（r=0.48，P=0.008）和熵（r=-0.52，P=0.004）显著相关。调整患者因素的多元线性回归显示，平均团队轨迹（调整后的 R2=0.335；系数，10.51[95%CI，8.81-12.21]；P=0.004）和团队位移熵（调整后的 R2=0.304；系数，-12.64[95%CI，-20.54 至-4.74]；P=0.003）与 NOTSS 评分相关。
本研究表明，在心脏手术过程中，OR 团队的运动与 NOTSS 对非技术技能的评分之间存在显著关联，这表明自动手术录像分析可以增强非技术技能评估。需要在不同的医院和专业领域进行进一步调查，以验证这些发现。
