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Special Issue "Peri-Operative Adverse Events in Surgery and Anesthesiology: How to Assess, Prevent and Manage Them?"

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: 15 October 2023 | Viewed by 6906

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Dr. Giovanni E. Cacciamani

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Guest Editor

Institute of Urology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
Interests: surgery; complications reporting; bladder cancer; artificial intelligence; patients safety; urology; minimally invasive surgery; adverse events; evidence-based medicine; quality reporting improvement
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Dear Colleagues,

Measuring the quality of health care delivery has been a key point of interest for policymakers due to the increasing demand and cost of health care. These quality metrics are typically based on outcomes data, and therefore this data must be standardized and reproducible. Further, these metrics inform hospital training initiatives, compensation profit margins, and insurance reimbursement, which may ultimately impact the quality-of-care delivery and total costs. To that end, one essential component of evaluating quality outcomes for surgeries is through the identification of negative outcomes, such as adverse events (AEs).

Almost 20 years ago, Martin et al. reviewed the available reporting systems used for surgical adverse events, to establish a possible change in attitude towards reporting of complications using standardized systems; after that, the Clavien–Dindo system was proposed to improve the adverse events reporting of post-operative complications, and now is currently widely used for the reporting of post-operative complications related to surgical interventions. More recently, in order to address the gaps in the intraoperative adverse events reporting, the Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration was established to present recommendations for the development and implementation of future reporting systems that are focused on the intraoperative surgical and anesthesiological outcomes.

This Special Issue of the Journal of Clinical Medicine aims to establish best-practice and expert opinion recommendations on intra-operative and post-operative adverse events. The authors are tasked with addressing four key components of perioperative adverse events: 1) assessment; 2) reporting; 3) analysis of possibly anticipable factors (patients, disease and surgical characteristics that might have an impact on the surgical and anesthesiological adverse events) and 4) management.

This information is of considerable interest and its practical usability might have important implications for both academic and clinical practice. Editors and reviewers should suggest assessing and reporting as an outcome of interest for quality and training purposes. The choice of the correct outcome reporting tool is of paramount importance, and failing to choose the appropriate system could potentially lead to reporting data that are far from reality. Surgeons should prioritize assessing and reporting adverse events to standardize the management of these events. Ultimately, these efforts will uncover the true impact of these events on patients’ peri-operative course.

Dr. Giovanni E. Cacciamani
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

complications
adverse events
surgical safety
complications management
prevention of complications, intraoperative complications
postoperative complications
perioperative complications

Published Papers (5 papers)

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Editorial

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Open AccessEditorial

Strategies for Improving the Standardization of Perioperative Adverse Events in Surgery and Anesthesiology: “The Long Road from Assessment to Collection, Grading and Reporting”

and

Giovanni E. Cacciamani

J. Clin. Med. 2022, 11(17), 5115; https://doi.org/10.3390/jcm11175115 - 30 Aug 2022

Cited by 5 | Viewed by 1036

Abstract

The assessment, collection, and reporting of all aspects of surgical procedures are crucial for optimizing patient safety and improving surgical/procedural quality [...] Full article

(This article belongs to the Special Issue Peri-Operative Adverse Events in Surgery and Anesthesiology: How to Assess, Prevent and Manage Them?)

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Open AccessEditorial

If You Know Them, You Avoid Them: The Imperative Need to Improve the Narrative Regarding Perioperative Adverse Events

and

Giovanni E. Cacciamani

J. Clin. Med. 2022, 11(17), 4978; https://doi.org/10.3390/jcm11174978 - 25 Aug 2022

Cited by 7 | Viewed by 1044

Abstract

There are few things in life as exciting as growing up in the countryside [...] Full article

(This article belongs to the Special Issue Peri-Operative Adverse Events in Surgery and Anesthesiology: How to Assess, Prevent and Manage Them?)

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Research

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Open AccessArticle

Superior Mesenteric Artery Injury during Robotic Radical Nephrectomy: Scenarios and Management Strategies

Giovanni E. Cacciamani

and

J. Clin. Med. 2023, 12(2), 427; https://doi.org/10.3390/jcm12020427 - 05 Jan 2023

Viewed by 2138

Abstract

Injury to the superior mesenteric artery (SMA) is a rare, underreported, and potentially devastating complication. This study aims to propose a systematic workup to describe how to prevent and manage SMA injury in a standardized stepwise manner. Three different instances of intraoperative injury to the SMA are described in an accompanying video. All three occurred when the SMA was misidentified as the left renal artery during left robotic radical nephrectomy. In the first case, the SMA was mistakenly identified as the renal artery, but after further dissection, the real renal artery was identified and SMA injury was prevented. In the second case, the SMA was clipped and the real left renal artery was subsequently identified, requiring clip removal. In the third case, the SMA was clipped and completely transected, requiring prompt repair by vascular surgery with a successful outcome. This study aims to propose a systematic workup to describe how to prevent and manage SMA injury in a standardized stepwise manner. The proper anatomic recognition of the SMA may prevent its injury. Intraoperative SMA injury should be promptly identified and repaired to avoid its devastating consequences. Full article

(This article belongs to the Special Issue Peri-Operative Adverse Events in Surgery and Anesthesiology: How to Assess, Prevent and Manage Them?)

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Review

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Open AccessReview

Risk Prediction Models for Peri-Operative Mortality in Patients Undergoing Major Vascular Surgery with Particular Focus on Ruptured Abdominal Aortic Aneurysms: A Scoping Review

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J. Clin. Med. 2023, 12(17), 5505; https://doi.org/10.3390/jcm12175505 - 24 Aug 2023

Viewed by 286

Abstract

Purpose. The present scoping review aims to describe and analyze available clinical data on the most commonly reported risk prediction indices in vascular surgery for perioperative mortality, with a particular focus on ruptured abdominal aortic aneurysm (rAAA). Materials and Methods. A scoping review following the PRISMA Protocols Extension for Scoping Reviews was performed. Available full-text studies published in English in PubMed, Cochrane and EMBASE databases (last queried, 30 March 2023) were systematically reviewed and analyzed. The Population, Intervention, Comparison, Outcome (PICO) framework used to construct the search strings was the following: in patients with aortic pathologies, in particular rAAA (population), undergoing open or endovascular surgery (intervention), what different risk prediction models exist (comparison), and how well do they predict post-operative mortality (outcomes)? Results. The literature search and screening of all relevant abstracts revealed a total of 56 studies in the final qualitative synthesis. The main findings of the scoping review, grouped by the risk score that was investigated in the original studies, were synthetized without performing any formal meta-analysis. A total of nine risk scores for major vascular surgery or elective AAA, and 10 scores focusing on rAAA, were identified. Whilst there were several validation studies suggesting that most risk scores performed adequately in the setting of rAAA, none reached 100% accuracy. The Glasgow aneurysm score, ERAS and Vancouver score risk scores were more frequently included in validation studies and were more often used in secondary studies. Unfortunately, the published literature presents a heterogenicity of results in the validation studies comparing the different risk scores. To date, no risk score has been endorsed by any of the vascular surgery societies. Conclusions. The use of risk scores in any complex surgery can have multiple advantages, especially when dealing with emergent cases, since they can inform perioperative decision making, patient and family discussions, and post hoc case-mix adjustments. Although a variety of different rAAA risk prediction tools have been published to date, none are superior to others based on this review. The heterogeneity of the variables used in the different scores impairs comparative analysis which represents a major limitation to understanding which risk score may be the “best” in contemporary practice. Future developments in artificial intelligence may further assist surgical decision making in predicting post-operative adverse events. Full article

(This article belongs to the Special Issue Peri-Operative Adverse Events in Surgery and Anesthesiology: How to Assess, Prevent and Manage Them?)

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Other

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Open AccessSystematic Review

Automated Capture of Intraoperative Adverse Events Using Artificial Intelligence: A Systematic Review and Meta-Analysis

Giovanni E. Cacciamani

and

Mitchell G. Goldenberg

J. Clin. Med. 2023, 12(4), 1687; https://doi.org/10.3390/jcm12041687 - 20 Feb 2023

Cited by 2 | Viewed by 1730

Abstract

Intraoperative adverse events (iAEs) impact the outcomes of surgery, and yet are not routinely collected, graded, and reported. Advancements in artificial intelligence (AI) have the potential to power real-time, automatic detection of these events and disrupt the landscape of surgical safety through the prediction and mitigation of iAEs. We sought to understand the current implementation of AI in this space. A literature review was performed to PRISMA-DTA standards. Included articles were from all surgical specialties and reported the automatic identification of iAEs in real-time. Details on surgical specialty, adverse events, technology used for detecting iAEs, AI algorithm/validation, and reference standards/conventional parameters were extracted. A meta-analysis of algorithms with available data was conducted using a hierarchical summary receiver operating characteristic curve (ROC). The QUADAS-2 tool was used to assess the article risk of bias and clinical applicability. A total of 2982 studies were identified by searching PubMed, Scopus, Web of Science, and IEEE Xplore, with 13 articles included for data extraction. The AI algorithms detected bleeding (n = 7), vessel injury (n = 1), perfusion deficiencies (n = 1), thermal damage (n = 1), and EMG abnormalities (n = 1), among other iAEs. Nine of the thirteen articles described at least one validation method for the detection system; five explained using cross-validation and seven divided the dataset into training and validation cohorts. Meta-analysis showed the algorithms were both sensitive and specific across included iAEs (detection OR 14.74, CI 4.7–46.2). There was heterogeneity in reported outcome statistics and article bias risk. There is a need for standardization of iAE definitions, detection, and reporting to enhance surgical care for all patients. The heterogeneous applications of AI in the literature highlights the pluripotent nature of this technology. Applications of these algorithms across a breadth of urologic procedures should be investigated to assess the generalizability of these data. Full article

(This article belongs to the Special Issue Peri-Operative Adverse Events in Surgery and Anesthesiology: How to Assess, Prevent and Manage Them?)

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