Importance of Intraoperative Detection of Graft Patency by Using Transit Time Flowmetry and Its Impact on Revascularization of the Myocardium

Background Coronary artery bypass surgery (CABG) has contributed to an increase in survival, quality of life and life expectancy. The anastomotic quality and graft patency is directly associated with both early and long-term clinical results after CABG. It is a complication that can lead to refractory angina, myocardial infarction, arrhythmias, and even mortality. Objectives This study was aiming to evaluate the effect of use of TTFM on the outcome of CABG operations and it was carried out on 100 patients and examined 282 grafts, we use inotropic agents to maintain the systolic pressure at 90- 100 mmHg if the blood pressure was lower than that limit. Patients and Methods An observational exploratory study was carried on 100 patients operated in Police authority hospitals, cardiothoracic surgery department. The study period of the study was 6 months, study population: The included population will be patients with Coronary Artery Disease (CAD) undergoing Coronary Artery Bypass Grafting (CABG) surgery. Results TTFM data was described as two main readings which are MF in ml/min (mean flow), PI (pulsatility index) and it was measured for the all types of the grafts. In MF it was the highest in AO-OM system (34.5 ± 18.46) followed by LIMA- LAD system (33.0 ± 19.65) then AO-Diagonal (31.0 ± 26.38) and lastly AO-RCA(29.50 ± 32.22). For the PI the lowest measurements was 0.8 and it was for both LIMA to LAD and then 1.2 for AO-OM system and 1.4 for AO-DIAG system and 1.8 for AO-RCA system. The most important finding in this study which represents the usefulness of the usage of TTFM is how much grafts needed to be revised according to the grafts measurements and it was 14 grafts in 14 patients (one grafts for each patient) among 100 patients which account for 14%. Conclusion Regarding the other studies that compare the TTEM with other ways for detection of graft patency, they prefer the TTFM due to: TTFM is easy to use, accurate and relatively inexpensive, TTFM helps prevent missed technical surgical errors in distal and proximal anastomosis, it has shown that TTFM improved outcome in many situations, TTFM provides excellent documentation of the surgical outcome and allows for better understanding of procedural complications.

Optimized Thickness of Meniscal Component in Partial Knee Replacement Analysed with Computer Simulation

Computer simulation with programming and Matlab graphics was used to analyse effects of meniscal component thickness on lengths of ligament fibres in partially replaced human knee with uni-compartmental arthroplasty. A circular femoral, a flat tibial and a matching meniscal component were modelled in the sagittal plane with four intact ligaments represented as fibres that showed non-linear elastic behaviour. Shapes of the prosthetic components, attachments of the ligament fibres and their material properties were from anatomical studies in the literature. The components when placed on respective bones with surgical guidelines and an optimized thickness of the meniscal insert achieved nearly fixed lengths of ligament fibres during motion. Changes in thickness of the insert either stretched or slackened the fibres with variable effects during flexion of the joint. For example, a 2 mm thicker insert stretched a fibre of anterior cruciate ligament by 4.7% at 30° and 3.2% at 120° flexion. Such variations in component selection are probable due to surgical judgments. Stretched ligaments could increase joint stiffness, while slack ligaments could increase joint laxity – either of these effects has potential for affecting the joint kinematics. Computer models of the replaced knee validated with anatomical studies allow insight in the mechanics of the replaced knee and effects of surgical errors.

EP.FRI.374 Characteristics of Emergency General Surgery Operations at Night. An Avoidable Issue?

Aim Most hospitals mandate afterhours operations to permit only cases that are life or limb-threatening. This is in the interests of promoting patient safety and reducing surgical errors. The incidence and caseload of night-time operations has not been well defined in Australia. This study aims to investigate the characteristics emergency operations involving consultant general surgeons between 10pm to 7am in regional and rural hospitals. Methods A multicentre, prospectively collected health service database of all emergency general surgery operations performed over a 12-month period was reviewed. In particular, patient demographics, type of operation, primary surgeon and time of operation were analysed. Results There were a total of 2059 emergency operations performed with 1344 cases performed in the regional hospital and 715 performed in the rural hospital within the area health network. Consultant surgeons were involved in 62 cases at night beyond 10.00pm, of which majority were laparotomies (n = 26/62, 42%), appendicectomies (n = 21/62, 34%), and hernia repair ((n = 4/62, 6.5%). In comparison, surgeons in the rural hospital performed seven emergency cases at night comprising of 6 laparotomies and one abscess drainage. Conclusion Larger hospitals have higher volumes of emergency cases, which increases the likelihood of afterhours operating. The rural hospital does not have other subspecialty cover competing for emergency operating time. This allows most emergency cases to be performed in the evening. In order to promote safe working hours and improved patient safety, theatre availability and staffing could be increased in the evening to diminish necessity for midnight to morning consultant operations.

Prevalence of Surgical Flow Disruptions Across Intra-operative High- and Low-Workload Phases in Cardiac Surgery

While the influence of surgical flow disruptions (SFDs) on surgical performance has been observed in live cardiovascular surgery and their influence on cognitive workload has been evaluated in high-fidelity simulations, the relationship between SFDs and cognitive workload of surgical providers in the live cardiac surgery operating room has yet to be explored. Recent evidence suggests that preventable surgical errors often have a cognitive basis, warranting investigation into the association between SFDs and workload. This study aimed to characterize SFDs according to auditory and cognitive domains and further to compare the frequency and nature of SFDs within periods of high team cognitive workload and low team cognitive workload. Overall, the presence of cognitive distractions was associated more with high team cognitive workload states, while the frequency of auditory distractions was significantly higher during periods of low team cognitive workload states. Future work should consider the types, frequency, and sources of SFDs as well as their impact on surgical procedures and outcomes in order to devise appropriate methods to mitigate or manage potential disruptions to surgical workflow.

Interprofessional work in operating rooms: a qualitative study from Sri Lanka

Background A growing body of research shows links between poor teamwork and preventable surgical errors. Similar work has received little attention in the Global South, and in South Asia, in particular. This paper describes surgeons’ perception of teamwork, team members’ roles, and the team processes in a teaching hospital in Sri Lanka to highlight the nature of interprofessional teamwork and the factors that influence teamwork in this setting. Methods Data gathered from interviews with 15 surgeons were analyzed using a conceptual framework for interprofessional teamwork. Results Interprofessional teamwork was characterized by low levels of interdependency and integration of work. The demarcation of roles and responsibilities for surgeons, nurses, and anesthetists appeared to be a strong element of interprofessional teamwork in this setting. Various relational factors, such as, professional power, hierarchy, and socialization, as well as contextual factors, such as, patriarchy and gender norms influenced interprofessional collaboration, and created barriers to communication between surgeons and nurses. Junior surgeons derived their understanding of appropriate practices mainly from observing senior surgeons, and there was a lack of formal training opportunities and motivation to develop non-technical skills that could improve interprofessional teamwork in operating rooms. Conclusions A more nuanced view of interprofessional teamwork can highlight the different elements of such work suited for each specific setting. Understanding the relational and contextual factors related to and influencing interprofessional socialization and status hierarchies can help improve quality of teamwork, and the training and mentoring of junior members.

Interprofessional work in operating rooms: a qualitative study from Sri Lanka

Background A growing body of research shows links between poor teamwork and preventable surgical errors. Similar work has received little attention in the Global South, and in South Asia, in particular. This paper describes surgeons’ perception of teamwork, team members’ roles, and the team processes in a teaching hospital in Sri Lanka to highlight the nature of interprofessional teamwork and the factors that influence teamwork in this setting. Methods Data gathered from interviews with 15 surgeons were analyzed using a conceptual framework for interprofessional teamwork. Results Interprofessional teamwork was characterized by low levels of interdependency and integration of work. The demarcation of roles and responsibilities for surgeons, nurses, and anesthetists appeared to be a strong element of interprofessional teamwork in this setting. Various relational factors, such as, professional power, hierarchy, and socialization, as well as contextual factors, such as, patriarchy and gender norms influenced interprofessional collaboration, and created barriers to communication between surgeons and nurses. Junior surgeons derived their understanding of appropriate practices mainly from observing senior surgeons, and there was a lack of formal training opportunities and motivation to develop non-technical skills that could improve interprofessional teamwork in operating rooms. Conclusions A more nuanced view of interprofessional teamwork can highlight the different elements of such work suited for each specific setting. Understanding the relational and contextual factors related to and influencing interprofessional socialization and status hierarchies can help improve quality of teamwork, and the training and mentoring of junior members.

Decreasing the Surgical Errors by Neurostimulation of Primary Motor Cortex and the Associated Brain Activation via Neuroimaging

Acquisition of fine motor skills is a time-consuming process as it is based on learning via frequent repetitions. Transcranial electrical stimulation (tES) is a promising means of enhancing simple motor skill development via neuromodulatory mechanisms. Here, we report that non-invasive neurostimulation facilitates the learning of complex fine bimanual motor skills associated with a surgical task. During the training of 12 medical students on the Fundamentals of Laparoscopic Surgery (FLS) pattern cutting task over a period of 12 days, we observed that transcranial direct current stimulation (tDCS) decreased error level and the variability in performance, compared to the Sham group. Furthermore, by concurrently monitoring the cortical activations of the subjects via functional near-infrared spectroscopy (fNIRS), our study showed that the cortical activation patterns were significantly different between the tDCS and Sham group, with the activation of primary motor cortex (M1) and prefrontal cortex (PFC) contralateral to the anodal electrode significantly decreased while supplemental motor area (SMA) increased by tDCS. The lowered performance errors were retained after 1-month post-training. This work supports the use of tDCS to enhance performance accuracy in fine bimanual motor tasks.