53 - Séance de prix
British Journal of Surgery Session BJS Lecture & BJS-Paper Session inkl. Award ceremony
3 juin 2021, 15:25 - 17:30, Stream 1 - 4
Effects of structured intraoperative briefings on patient outcomes: A multicentric before and after study using inverse probability weighting
F. Tschan1, S. Keller2, N. K. Semmer2, E. Timm-Holzer1, J. Zimmermann1, S. A. Huber1, S. Wrann3, V. Banz2, G. A. Prevost2, M. Hübner4, D. Candinas2, N. Demartines4, M. Weber3, G. Beldi2, Presenter: G. Beldi2 (1Neuchâtel, 2Bern, 3Zurich, 4Lausanne)
Surgical procedures, performed by closely interacting multidisciplinary teams, remain associated with significant morbidity and mortality. We hypothesized that enhancing team communication during the operation improves patient outcomes.
In a before-and-after design, intraoperative briefings were introduced in four centers for general, non-cardiac surgery in 8256 patients. Before critical phases of the operation, the responsible surgeon initiated and led the StOP?-protocol and informed all team members about the progress of the operation (Status), next steps and proximal goals (Objectives), and possible problems (Problems), and encouraged to ask questions (?). Differences between baseline and intervention periods were analyzed with regard to surgical site infections, mortality (primary outcomes), unplanned reoperations, and length of stay (secondary outcomes), using inverse probability weighting based on propensity score matching and adjusting for covariates.
End-point data were available for 7745 (93·8%) patients. Documented StOP?-protocols were performed in 2403 (61·2%) of the operations during the intervention period. Adjusted intention-to-treat analyses showed no differences for surgical site infections between baseline (9·75%) and intervention (9·59%); (adjusted absolute difference (AD) -0·15%, 95% confidence interval (CI) -1·45 to 1·14; odds ratio (OR) 0·92, CI 0·83 to 1·15; p=0·797), but showed lower mortality (baseline: 1·59%, intervention 1·05%; AD -0·54%, CI -1·039 to -0·033; OR 0·60; CI 0·39 to 0·92; p=0·018), less unplanned reoperations (baseline 6·44%, intervention 4·79%, AD -1·66%, CI -2·69 to -0·62; OR 0·72; CI, 0·59 to 0·89; p=0·002), and fewer long hospital stays during the intervention (19·82%) vs the baseline (21·64%) (AD -1·82%, CI -3·48 to -0·15; OR 0·87; CI, 0·77-0·98; p=0·024). Per-protocol analyses supported these findings.
The StOP? protocol was related to a reduction in mortality, unplanned reoperations, and length of stay. This short and flexible structured intraoperative briefing should be considered for surgical procedures to improve patient outcomes.