Abstract
Background
Surgeons are not required to train on energy-based devices or document their knowledge of safety issues related to their use. Their understanding of how to safely use the devices has never formally been tested. This study assessed that knowledge in a cohort of gastrointestinal surgeons and determined if key facts could be learned in a half-day course.
Methods
SAGES piloted a postgraduate CME course on the Fundamental Use of Surgical Energy™ (FUSE) at the 2011 SAGES meeting. Course faculty prepared an 11-item multiple-choice examination (pretest) of critical knowledge. We administered it to members of the SAGES board; Quality, Outcomes and Safety Committee; and FUSE Task Force. Postgraduate course participants took the pretest, and at the end of the course they took a 10-item post-test that covered the same content. Data are expressed as median (interquartile range, IQR).
Results
Forty-eight SAGES leaders completed the test: the median percent of correct answers was 59 % (IQR = 55–73 %; range = 0–100 %). Thirty-one percent did not know how to correctly handle a fire on the patient; 31 % could not identify the device least likely to interfere with a pacemaker; 13 % did not know that thermal injury can extend beyond the jaws of a bipolar instrument; and 10 % thought a dispersive pad should be cut to fit a child. Pretest results for 27 participants in the postgraduate course were similar, with a median of 55 % correct (IQR = 46–82 %). Participants were not told the correct answers. At the end of the course, 25 of them completed a different 10-item post-test, with a median of 90 % correct (IQR = 70–90 %).
Conclusions
Many surgeons have knowledge gaps in the safe use of widely used energy-based devices. A formal curriculum in this area can address this gap and contribute to increased safety.
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References
O’Connor JL, Bloom DA, William T (1996) Bovie and electrosurgery. Surgery 119(4):390–396
Schwaitzberg SD (2012) Evolutions and revolutions in surgical energy. In: Feldman LS, Fuchshuber P, Jones DB (eds) The fundamental use of surgical energy (FUSE) manual. Springer, New York
ECRI Institute (2010) Health devices: top 10 health technology hazards for 2011. Available at https://www.ecri.org/Products/Pages/Top-10-Hazards-Resources.aspx. Accessed January 13, 2012
Nduka CC, Super PA, Monson JR, Darzi AW (1994) Cause and prevention of electrosurgical injuries in laparoscopy. J Am Coll Surg 179(2):161–170
Carroll L (2011) Operating room fires hurt hundreds each year. Today health. Available at http://today.msnbc.msn.com/id/45117440/ns/today-today_health/t/operating-room-fires-hurt-hundreds-each-year/#.TxiVaKVSQyI. Accessed January 19, 2012
Emergency Care Research Institute (ECRI) (ed) (2009) New clinical guide to surgical fire prevention in health devices. ECRI, Plymouth Meeting, PA
U.S. Food and Drug Administration (2012) Preventing surgical fires. Available at http://www.fda.gov/Drugs/DrugSafety/SafeUseInitiative/PreventingSurgicalFires/default.htm. Accessed January 19, 2012
Hyslop JW, Maull KI (1982) Natural history of the retained surgical sponge. South Med J 75(6):657–660
Kwaan MR, Studdert DM, Zinner MJ, Gawande AA (2006) Incidence, patterns, and prevention of wrong-site surgery. Arch Surg 141(4):353–357 discussion 357–358
Wu MP, Ou CS, Chen SL, Yen EY, Rowbotham R (2000) Complications and recommended practices for electrosurgery in laparoscopy. Am J Surg 179(1):67–73
El-Hakim A, Aldana JP, Reddy K, Singhal P, Lee BR (2005) Laparoscopic bowel injury in an animal model: monocyte migration and apoptosis. Surg Endosc 19(4):484–487
Brill AI, Feste JR, Hamilton TL, Tsarouhas AP, Berglund SR, Petelin JB, Perantinides PG (1998) Patient safety during laparoscopic monopolar electrosurgery: principles and guidelines. Consortium on electrosurgical safety during laparoscopy. JSLS 2(3):221–225
AORN Recommended Practices Committee (2005) Recommended practices for electrosurgery. AORN J 81(3):616–618, 621–626, 629–632 passim
Tucker RD, Voyles CR (1995) Laparoscopic electrosurgical complications and their prevention. AORN J 62(1):51–53, 55, 58–59 passim; quiz 74–77
Acknowledgments
The authors thank Rita Buckley for editing the manuscript and Sallie Mathews and Carla Bryant for their contributions to the FUSE project.
Disclosures
Steven Schwaitzberg has served on and as a consultant to Endocore during the past 3 years. He has ongoing consultant activities with Olympus, Stryker, Surgiquest, Neatstitch, Cambridge Endo, and Acuity Bio. Liane S. Feldman, Pascal Fuchshuber, Daniel B. Jones, and Jessica Mischna, have no conflicts of interest or financial ties to disclose.
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Oral presentation at The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Annual Meeting, San Diego, CA, March 7–10, 2012.
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Feldman, L.S., Fuchshuber, P., Jones, D.B. et al. Surgeons don’t know what they don’t know about the safe use of energy in surgery. Surg Endosc 26, 2735–2739 (2012). https://doi.org/10.1007/s00464-012-2263-y
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DOI: https://doi.org/10.1007/s00464-012-2263-y