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Patient Safety in the Operating Room During Urologic Surgery: The OR Black Box Experience

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Abstract

Purpose

To mitigate intraoperative adverse events, it is important to understand the context in which these errors occur. The purpose of this study is to characterize the IAEs and potential distractions that occur in minimally invasive urologic procedures.

Methods

We conducted a prospective cohort study in patients undergoing laparoscopic urologic surgery at an academic health center. The OR Black Box, a unique technology system which captures video and audio recordings of the operating room as well as the operative field, was used to collect data regarding procedure type, critical step, IAEs, and distractions.

Results

Of a total of 80 cases analyzed, the majority of these cases were partial nephrectomy (n = 36; 45%), radical nephrectomy (n = 20; 25%), and adrenalectomy (n = 4; 5%). Across all cases, there were a total of 138 clinically significant IAEs, 10 of which (14%) were of the highest severity (five on the SEVerity of intraoperative Events and Rectification Tool (SEVERE) matrix). Of these, 70 (51%) occurred during an a priori defined critical step of the operation. Distractions were common across all cases. The median rate of external communication per case was 16 events (IQR 11-22); and per critical step was 4 (IQR 2.75-8), while median room traffic per case was 65 entries/exits (IQR 42-76); and per critical step was 17 (IQR 10-65).

Conclusion

Our data demonstrate that IAEs occur frequently during all phases of the operation at hand. Future study will be required to examine the role of distractions and IAE as well as IAE and their relationship to post-operative clinical outcomes.

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Acknowledgements

Surgical Safety Technologies aided in the collection and analysis of the data as all data are centralized with their team post-collection in the operating room. In particular, we acknowledge Vanessa Palter, MD, Stephen Townsend, Daisy De La Cruz, Adolfo Rios, and Juliano Montes for their assistance in OBB setup and data analysis.

Funding

No grant funding was required for this research.

Author information

Authors and Affiliations

  1. Smith Institute for Urology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, 450 Lakeville Road, New Hyde Park, Hempstead, NY, 11042, USA

    A. Rai, L. Beland, T. Aro & L. Kavoussi

  2. Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, Hempstead, NY, 11042, USA

    M. Jarrett

Authors
  1. A. Rai
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  2. L. Beland
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  3. T. Aro
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  4. M. Jarrett
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  5. L. Kavoussi
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Contributions

AR contributed to data collection, data analysis, manuscript writing/editing, LB contributed to data analysis, manuscript editing, TA contributed to manuscript editing, MJ contributed to protocol development, manuscript editing, and LK contributed to protocol development, data collection, manuscript editing.

Corresponding author

Correspondence to A. Rai.

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Conflicts of interest

All of the others declare no conflicts of interests.

Ethics approval

This study was covered under an institutional quality improvement initiative and waived the need for participation or publication consent.

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Rai, A., Beland, L., Aro, T. et al. Patient Safety in the Operating Room During Urologic Surgery: The OR Black Box Experience. World J Surg 45, 3306–3312 (2021). https://doi.org/10.1007/s00268-021-06251-9

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  • DOI: https://doi.org/10.1007/s00268-021-06251-9

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