Emergent robotic surgery conversions: improving operating room team performance through high fidelity simulations.

Background: Although robotic surgery has gained popularity, safety concerns remain due to potential delay in addressing intraoperative hemorrhages since the surgeon is not at the bedside. This study aimed to test whether a training program for emergency robotic undocking protocols improved the performance of thoracic operating room (OR) teams.

Methods: An emergency undocking protocol and checklists were created for massive hemorrhage during robotic thoracic surgery.

Use of In-Situ Simulation Based Clinical Systems Test of Thoracic Robotic Surgery Emergencies.

Introduction: With the advancement of robotic surgery, some thoracic surgeons have been slow to adopt to this new operative approach, in part because they are un-scrubbed and away from the patient while operating. Aiming to allay surgeon concerns of intra-operative emergencies, an insitu simulation-based clinical system's test (SbCST) can be completed to test the current clinical system, and to practice low-frequency, high-stakes clinical scenarios with the entire operating room (OR) team.

Methods: Six different OR teams completed an insitu SbCST of an intra-operative pulmonary artery injury during a robot-assisted thoracic surgery at a single tertiary care center.

CO embolism can complicate transanal total mesorectal excision.

Background: Carbon dioxide (CO) embolism is a rare but potentially devastating complication of minimally invasive abdominal and retroperitoneal surgery. Characterized by a decrease in end-tidal CO (ETCO) and oxygen saturation (SpO), CO emboli can cause rapid intraoperative hypotension and cardiovascular collapse. Transanal total mesorectal excision (taTME) is a novel surgical approach for rectal resection, which requires high flow CO insufflation in a low volume operative field.

Randomized Controlled Study of a Remote Flipped Classroom Neuro-otology Curriculum.

Context: Medical Education can be delivered in the traditional classroom or novel technology including an online classroom.

Objective: To test the hypothesis that learning in an online classroom would result in similar outcomes as learning in the traditional classroom when using a flipped classroom pedagogy.

Design: Randomized controlled trial.

Extubation of the difficult airway.

Managing the airway in the intensive care unit (ICU) is complicated by a wide array of physiologic factors. Difficult airway may be a consequence of patient’s anatomy or airway edema developed during the ICU stay and mechanical ventilation. The incidence of failed airways and of cardiac arrest related to airway instrumentation in the ICU is much higher than that of elective intubations performed in the operating room.

Long-term complications of medical patients with hospital-acquired venous thromboembolism.

Long-term complications from hospital-acquired acute venous thromboembolism (VTE) include recurrent VTE, postthrombotic syndrome (PTS), and chronic thromboembolic pulmonary hypertension (CTEPH). We used a probability model to estimate the number of these events among hospitalised medical patients in the 2003 United States Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample database. Of 8,077,919 hospitalised medical patients at risk for VTE, we calculate that 122,235 were stricken with deep vein thrombosis (DVT) and 32,654 with pulmonary embolism (PE).

Venous thromboembolic events in hospitalised medical patients.

The number of acutely ill hospitalised medical patients at risk for acute venous thromboembolism (VTE) has not been well defined. Therefore, we used the 2003 United States Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample database to estimate VTE events among hospitalised medical patients. We then modeled the potential reduction in VTE with universal utilisation of appropriate pharmacological thromboprophylaxis.

Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study.

Background: Information about the variation in the risk for venous thromboembolism (VTE) and in prophylaxis practices around the world is scarce. The ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting) study is a multinational cross-sectional survey designed to assess the prevalence of VTE risk in the acute hospital care setting, and to determine the proportion of at-risk patients who receive effective prophylaxis.

Methods: All hospital inpatients aged 40 years or over admitted to a medical ward, or those aged 18 years or over admitted to a surgical ward, in 358 hospitals across 32 countries were assessed for risk of VTE on the basis of hospital chart review.

Perioperative mortality for pancreatectomy: a national perspective.

Objective: To analyze in-hospital mortality after pancreatectomy using a large national database.

Summary And Background Data: Pancreatic resections, including pancreaticoduodenectomy, distal pancreatectomy, and total pancreatectomy, remain the only potentially curative interventions for pancreatic cancer. The goal of this study was to define factors affecting outcomes after pancreatectomy for neoplasm.

Estimated annual numbers of US acute-care hospital patients at risk for venous thromboembolism.

Venous thromboembolism (VTE) is a major US health problem. However, the total number of US inpatients who are at risk for VTE is unknown. Our objective was to estimate the number of US acute-care hospital inpatients who were at risk for VTE according to criteria established by the Seventh American College of Chest Physicians (ACCP) Consensus Conference on Antithrombotic and Thrombolytic Therapy guidelines for VTE prevention.

Airway management in critical illness.

Airway management in the ICU can be complicated due to many factors including the limited physiologic reserve of the patient. As a consequence, the likelihood of difficult mask ventilation and intubation increases. The incidence of failed airways and of cardiac arrest related to airway instrumentation in the ICU is much higher than that of elective intubations performed in the operating room.

The adverse effects of race, insurance status, and low income on the rate of amputation in patients presenting with lower extremity ischemia.

Objectives: A consequence of delay in the diagnosis of peripheral vascular disease limb loss. This study was undertaken to determine the correlation of low socioeconomic status and race on the severity of ischemic presentation and the subsequent amputation rate.

Methods: Data from the Nationwide Inpatient Sample (NIS) from 1998 to 2002 on patients from urban hospitals with the diagnosis of lower extremity ischemia were evaluated.