PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Surgical Performance”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 91 records · Page 5Linked to original sources
PubMed2004

Developing observational measures of performance in surgical teams.

Team performance is increasingly recognised as an essential foundation of good surgical care and a determinant of good surgical outcome. To understand team performance and to develop team training, reliable and valid measures of team performance are necessary. Currently there is no firm consensus on how to measure teamwork, partly because of a lack of empirical data to validate measures. The input-process-output model provides a framework for surgical team studies. Objective observational measures are needed in surgery as a basis for interdisciplinary team assessment and training. The "observational teamwork assessment for surgery" (OTAS) tool assesses two facets of the surgical process. Observer 1 monitors specific tasks carried out by team members, under the categories patient, environment, equipment, provisions, and communications. Observer 2 uses a behavioural observation scale to rate behaviour for the three surgical phases (pre-operative, operative, and post-operative) with components of teamwork: cooperation, leadership, coordination, awareness, and communication. Illustrative data from an initial series of 50 cases is presented here. The OTAS tool enables two independent observers, a surgeon and psychologist, to record detailed information both on what the theatre team does and how they do it, and has the potential to identify constraints on performance that might relate to surgical outcome.

Humans↗
PubMed2004

A cross-sectional survey of clinicians performing periodontal surgical crown lengthening.

The aim of this study was to conduct a survey of surgical crown lengthening practice performed by dental specialists and general dental practitioners using a cross-sectional questionnaire. One hundred general dental practitioners and 100 specialists from each of the following specialties: prosthodontics, periodontics, restorative dentistry and surgical dentistry. There were fewer surgical dentists performing surgical crown lengthening than the other specialists. The specialists in periodontics were significantly more likely to perform surgical crown lengthening than not. The respondents predominantly considered that periodontal surgical crown lengthening is within the remit of periodontics. 33% of the respondents performing more than 50 PSCL procedures in one year thought that the gingival margin was stable after three months. 33% thought that it was stable after six months and 33% declined to state a post-operative marginal stability time period.

Cross-Sectional Studies↗
PubMed2003

Mortality control charts for comparing performance of surgical units: validation study using hospital mortality data.

OBJECTIVE: To design and validate a statistical method for evaluating the performance of surgical units that adjusts for case volume and case mix. DESIGN: Validation study using routinely collected data on in-hospital mortality. DATA SOURCES: Two UK databases, the ASCOT prospective database and the risk scoring collaborative (RISC) database, covering 1042 patients undergoing surgery in 29 hospitals for gastro-oesophageal cancer between 1995 and 2000. STATISTICAL ANALYSIS: A two level hierarchical logistic regression model was used to adjust each unit's operative mortality for case mix. Crude or adjusted operative mortality was plotted on mortality control charts (a graphical representation of surgical performance) as a function of number of operations. Control limits defined as 90%, 95%, and 99% confidence intervals identified units whose performance diverged significantly from the mean. RESULTS: The mean in-hospital mortality was 12% (range 0% to 50%). The case volume of the units ranged from one to 55 cases a year. When crude figures were plotted on the mortality control chart, four units lay outside the 90% control limit, including two outside the 95% limit. When operative mortality was adjusted for risk, three units lay outside the 90% limit and one outside the 95% limit. The model fitted the data well and had adequate discrimination (area under the receiver operating characteristics curve 0.78). CONCLUSIONS: The mortality control chart is an accurate, risk adjusted means of identifying units whose surgical performance, in terms of operative mortality, diverges significantly from the population mean. It gives an early warning of divergent performance. It could be adapted to monitor performance across various specialties.

Hospital Mortality↗
PubMedDate not supplied

Surgical cricothyrotomy performed by air ambulance flight nurses: a 5-year experience.

Limited information exists in the current medical literature regarding the performance of surgical cricothyrotomy by flight nurse personnel. We undertook a retrospective review of all flight records from our regional air ambulance service. The flight team transported 2,188 patients during this time; 69 patients required surgical cricothyrotomy for airway access. In all cases, the procedure was performed by a flight nurse working under a predefined airway protocol. Indications for the procedure were predominantly for maxillofacial trauma. A secure airway was established in 98.5% of the cases (68/69). Acute complications involved hemorrhage (3) and placement (3) with a complication rate of 8.7%. We conclude that surgical cricothyrotomy can be performed by well-trained flight nurses with a high success rate and an acceptable complication rate.

Adolescent↗
PubMed2004

What predicts surgical internship performance?

BACKGROUND: Variables associated with postgraduate year 1 (PGY-l) performance in surgical training have not been fully defined. METHODS: Mean composite PGY-l evaluation scores were calculated from responses to questionnaires mailed to surgical program directors of 87 surgical graduates from 1997 to 2001. We analyzed evaluation scores for associations with sex, surgical specialty choice, United States Medical Licensing Examination (USMLE) step 1 and step 2 scores, Alpha Omega Alpha (AOA) election, and third-year clerkships' grade point average (GPA). RESULTS: There were significant first-order associations between PGY-l performance evaluation score and each of USMLE step 2 score and GPA. In a multiple linear regression model that included sex, surgical specialty choice, USMLE step l and step 2 scores, AOA, and GPA, USMLE step 2 score was the only significant predictor of PGY-l performance. CONCLUSIONS: Multiinstitutional studies are warranted to determine the predictive value of USMLE step 2 scores in residency performance beyond PGY-l and to identify other predictors of surgical PGY-l performance.

Adult↗
PubMed1991

Safety of surgical procedures performed by residents.

The outcome of surgical procedures on the gallbladder performed by surgical residents in a university hospital was compared with the outcome of those performed by the attending staff. More than 60% of the operations (643/1084) were done by residents under the direct supervision of the attending surgeon. We found no differences in the rate of technical complications, postoperative morbidity and mortality, or length of hospitalization between the two groups. Thus, resident surgery under appropriate guidance is safe and does not compromise the quality of patient care or operative outcome.

Cholecystectomy↗
PubMed2005

Correlating motor performance with surgical error in laparoscopic cholecystectomy.

BACKGROUND: Analysis of motor performance in minimally invasive surgery (MIS) is a new field with applications in surgical training, surgical simulators, and robotics. Force/torque and derivatives of tool tip position (velocity, acceleration, and jerk) are examples of measures of motor performance (MMPs). Few studies have measured MMPs or have correlated MMPs with surgical performance during MIS on humans. The objectives of this study were to determine the feasibility of a novel multimodal system to quantify MMPs in laparoscopic cholecystectomy and to attempt to correlate MMPs with the magnitude of error as a measure of surgical performance. METHODS: Novice and expert surgeons performed laparoscopic cholecystectomies in two groups of three patients each. MMPs were obtained using a combination of optical and electromagnetic tool tip tracking and a force/torque sensor on a modified Maryland dissector. Error scores for laparoscopic cholecystectomy were calculated using a previously validated system. Novice and expert measurements were compared, and correlations were made between error scores and MMPs. RESULTS: Error scores were similar between novices and experts. Novice surgeons had a significantly greater mean velocity (566 +/- 83 vs 85 +/- 32 mm/s, p = 0.006) and acceleration (2,600 +/- 760 vs 440 +/- 174 mm/s2, p = 0.050) compared to expert surgeons. Force (16.5 +/- 4.6 vs 18.3 +/- 6.0 N, p = 0.829), position (121 +/- 25 vs 135 +/- 72 mm, p = 0.863), and jerk (19,600 +/- 7,410 vs 2,430 +/- 367 mm/s3, p = 0.138) were similar between groups. A positive correlation was found in novice surgeons between error score and jerk (Pearson correlation, 0.999; p = 0.035). CONCLUSIONS: It is feasible to quantify MMPs in laparoscopic cholecystectomy. Novice and expert surgeons can be differentiated by MMPs; moreover, there may be a positive correlation between jerk and error score in novice surgeons.

Adult↗
PubMed2006

Early exposure to haptic feedback enhances performance in surgical simulator training: a prospective randomized crossover study in surgical residents.

BACKGROUND: In the literature of skill acquisition and transfer of skills, it often is assumed that the rate of skill acquisition depends on what has been learned in a similar context (i.e., surgical simulators providing haptic feedback). This study aimed to analyze whether the addition of haptic feedback early in the training phase for image-guided surgical simulation improves performance. METHODS: A randomized crossover study design was used, in which 38 surgical residents were randomized to begin a 2-h simulator training session with either haptic or nonhaptic training followed by crossover after 1 h. The graphic context was a virtual upper abdomen. The residents performed two diathermy tasks. Two validated tests were used to control for differences in visual-spatial ability: the BasIQ general cognitive ability test and Mental Rotation Test A (MRT-A). RESULTS: After 2 h of training, the group that had started with haptic feedback performed the two diathermy tasks significantly better (p < 0.05, unpaired t-test). Only the group that had started with haptic training significantly improved during the last 1-h session (p < 0.01, paired t-test). CONCLUSION: The findings indicate that haptic feedback could be important in the early training phase of skill acquisition in image-guided surgical simulator training.

Abdomen↗
PubMed1991

Mechanical performance of surgical needle holders.

A new quantitative measurement of surgical needle holder performance has been described that records the forces (clamping moment) applied by the needle holder jaws to curved surgical needles. This test has been used to determine the applied clamping forces of four different surgical needle holders made by one manufacturer. By relating the magnitude of the clamping moment of needle holder to the resistance to bending of curved surgical needles, we propose a new scientific basis for selecting surgical needle and needle holders for wound closure.

Elasticity↗
PubMed1994

Intraoperative nursing activities performed by surgical technologists.

In this study of delegated intraoperative nursing activities performed by surgical technologists (STs) in low-risk and high-risk surgical procedures, 343 OR directors, perioperative nurses, and STs from rural, community, and medical center hospitals reported that STs frequently perform activities related to surgical counts, the sterile field, and equipment and supplies. Surgical technologists do not frequently perform tasks related to patient transportation, teaching, medication administration, OR environment, patient monitoring, and patients' rights. The investigator used nine competency statements of intraoperative nursing as a framework for the research instrument. Data analysis determined that the levels of risk in patient situations affects how frequently STs perform transportation, teaching, sterile field, OR environment, and patients' rights activities.

Clinical Competence↗
PubMed1995

The relationship between faculty ward evaluations, OSCE, and ABSITE as measures of surgical intern performance.

BACKGROUND: This study determined the degree to which ward evaluations, the American Board of Surgery In-Training Examination (ABSITE), and an Objective Structured Clinical Examination (OSCE) provide equivalent information about intern performance. METHODS: Twenty-two general surgery interns completed both the ABSITE and a 17-problem, 35-station OSCE. Faculty members completed several 12-item ward evaluations for each intern. Pearson product-moment correlations were employed to determine the degree of association among the various evaluation measures. RESULTS: The total OSCE score correlated with both the total ABSITE score and the overall ward evaluations, but the latter two measures did not correlate with each other. The ward evaluations identified the performance of 1 of the 22 interns (5%) as deficient, the ABSITE identified 9 (41%) as deficient in knowledge, and the OSCE 8 (36%). CONCLUSIONS: In the future, performance-based testing methods such as the OSCE should become more important as an evaluative parameter in assessing the clinical performance of postgraduate surgical trainees.

Attitude of Health Personnel↗
PubMedDate not supplied

Surgical procedures performed after refractive surgery.

BACKGROUND: Refractive surgical procedures have been performed for over one decade. The complications that cause visual disability are abnormalities in wound healing, residual ametropia, and/or severe irregular astigmatism. Many of these complications can be manifested clinically in terms of visually disabling problems (loss of best-corrected vision, glare, monocular diplopia, etc). Some of these complications require additional standard ophthalmic or refractive surgical procedures to restore vision. However, since these secondary procedures have been performed in only a few cases, we known little about their outcome. METHODS: We report the histopathologic analysis of 132 cases that have undergone a secondary surgical procedure following a primary keratorefractive procedure. We attempt to correlate the problems encountered with such secondary intervention with histopathologic information obtained from specimens that have been submitted to our pathology laboratory and that had undergone secondary surgical procedures. RESULTS: Many specimens displayed abnormalities in wound healing associated with visual difficulties such as loss of best corrected acuity, glare, and under- and overcorrection. A short time from the initial procedure to the time of secondary intervention was common. CONCLUSIONS: The combination of a secondary surgical or keratorefractive procedure can produce unpredictable refractive results. Judicious application of a refractive procedure and an appropriate time period before a second procedure is performed may reduce unexpected refractive complications.

Adult↗
PubMed2000

Chairpersons' opinions regarding quality control of surgical faculty performance in Japanese academic surgery departments.

BACKGROUND: The governance and power structure of the department of surgery depends to a large extent on the chairperson's decisions in Japanese medical schools. This paper reports the current collective opinions of surgery department chairpersons regarding the quality assessment of surgical faculty performance. METHODS: Surveyed were 78 chairpersons of general surgery departments from 72 Japanese medical schools. Chairpersons were questioned about administrative and organizational decision making: rank order requirements for full-time surgical faculties, coordination of staff for surgical operations, and performance outcome measures. RESULTS: In all, 68 (87%) chairpersons responded. When selecting surgical faculties, publishing competence (45%) and collaborative personality (44%) were the two foremost concerns of chairpersons. Teaching experience (0%) and board certification (2%) showed the lowest rate for the first priority among the 6 elements listed. The operator was mainly decided by the chairperson (63%) whereas the rest of the operative team members were decided by either the chairperson (28%), a specialty team (38%), or attending surgeons (32%). Thirty-three chairpersons (49%) of 68 respondents used the morbidity and mortality conference as the only available approach for assessing surgical performance on a regular basis, whereas the remaining half did not have routine outcome measures. CONCLUSIONS: The results of this study indicate that surgery department chairpersons deemed collaborative personality and publishing competence the two major requirements for candidates of surgical faculties. Although the morbidity and mortality conference is currently the only available approach for assessing surgical performance, the majority of chairpersons felt that outcome measures should be based on more objective and structured criteria.

Academic Medical Centers↗
PubMed2001

Survey of voiding dysfunction and urinary retention after anti-incontinence procedures.

OBJECTIVE: To describe trends in the management of prolonged voiding dysfunction and urinary retention after anti-incontinence procedures. METHODS: Physician members of the American Urogynecologic Society were queried by means of a two-page questionnaire regarding the management of prolonged voiding dysfunction and urinary retention after anti-incontinence procedures. RESULTS: A total of 344 (42%) of 825 questionnaires were completed and returned. Of the 344 respondents, 61% identified themselves as urogynecologists, 50% worked in a university-affiliated practice, and 26% had been in practice for 11-20 years. Respondents rarely encountered prolonged urinary retention after anti-incontinence procedures. Among the respondents, 30% allowed 3-6 months for resumption of spontaneous voiding before performing surgical revision, and 90% performed multichannel urodynamic studies before surgical revision. However, 66% performed surgical revision transabdominally when urinary retention occurred after retropubic urethropexy, and 61-81% of respondents performed surgical revision transvaginally when urinary retention followed needle suspension, pubovaginal sling, or tension-free vaginal tape procedures. A total of 90-96% did not perform an anti-incontinence procedure concomitantly with surgical revision. The majority of respondents reported spontaneous voiding in greater than 80% of patients, and recurrent stress urinary incontinence in less than 10% of patients after surgical revision. CONCLUSION: Although certain trends in the management of prolonged urinary retention after anti-incontinence procedures were identified, there was no clear consensus on the method of surgical revision used, nor the management of recurrent stress urinary incontinence after surgical revision. Randomized clinical trials are required to determine the optimal management of prolonged urinary retention after anti-incontinence procedures.

Female↗
PubMed1988

Hemodynamic consequences of right ventricular isolation: the contribution of the right ventricular free wall to cardiac performance.

Surgical isolation of the right ventricular free wall was performed in 10 dogs to evaluate both the hemodynamic effects of the procedure and the postoperative contribution of right ventricular free wall contraction to overall cardiac performance. Following the procedure, there was no significant differences in peak right ventricular systolic pressure, right atrial pressure, right ventricular stroke volume, or cardiac index. Cardiac index remained at preoperative levels over a wide range of filling pressures. However, there was a significant decrease in right ventricular stroke work (6.0 +/- 1.3 gm-m/m2 to 5.1 +/- 0.5 gm-m/m2; p less than 0.05). Pacing the isolated right ventricular free wall resulted in marked hemodynamic improvement compared with an electrically silent right ventricular free wall. Cardiac index increased from 1.7 +/- 0.2 L/min/m2 to 2.6 +/- 0.2 L/min/m2 (p less than 0.0005), and right ventricular stroke work went from 3.0 +/- 0.6 gm-m/m2 to 6.4 +/- 0.9 gm-m/m2 (p less than 0.0005). Right ventricular performance was also significantly related to the timing of right ventricular free wall contraction. Thus, the right ventricular free wall played an important role in the maintenance of normal cardiac hemodynamics.

Animals↗
PubMed2005

Quantitative measures of performance in microvascular anastomoses.

OBJECTIVE: Methods of evaluating surgical performance are mainly subjective. This study introduces a method of evaluating surgical performance using a quantitative analysis of tool tip kinematics. METHODS: One experienced surgeon performed eight rat microvascular anastomoses over a 2-day interval. An optoelectronic motion analysis system acquired tool tip trajectories at frequencies of 30 Hz. On the basis of a hierarchical decomposition, the procedure was segmented into specific surgical subtasks (free space movement, needle placement and knot throws) from which characteristic measures of performance (tool tip trajectory, excursion and velocity) were evaluated. Comparisons of performance measures across each procedure were indexed (D scale) using the Kolmogorov-Smirnov statistic. RESULTS: Despite the marker occlusions, tool tip data were obtained 92 +/- 7% (mean +/- SD) of the time during manipulation tasks. Missing data segments were interpolated across gaps of less than 10 sample points with errors less than 0.4 mm. The anastomoses were completed in 27 +/- 4 min (range 20.5-31.4 min) with 100% patency. Tool tip trajectories and excursions were comparable for each hand, while right and left hand differences were found for velocity. Performance measures comparisons across each procedure established the benchmark for an experienced surgeon. The D-scale range was between 0 and 0.5. CONCLUSION: The study establishes a reproducible method of quantitating surgical performance. This may enhance assessment of surgical trainees at various levels of training.

Anastomosis, Surgical↗