Background

The aim is to develop and test the utility of an event-initiated, team-based check list to optimize the response to bleeding during laparoscopic HPB surgery.

Methods

To build a checklist for managing bleeding events, we conducted a systematic review. Using nominal group technique (NGT), a checklist consisting of four domains was developed. Following team-based training of anesthesia and surgical staff, the checklist was implemented. HPB cases before and after implementation of the checklist were compared for adverse outcomes, bleeding complications, and transfusions.

Results

NGT identified four domains: Communicate Control, Expose, and Repair under which the checklist was organized. Supplemental Video for a detailed review of how each domain was applied to a specific case example. We compared 169 HPB cases before to 53 cases after implementation. We found a significant decrease in mean EBL (from 518 ± 852.8 to 151.5 ± 221.7 ml (P = 0.001)) for cases performed after implementation of the checklist and a trends toward less volume of pRBC transfused (2.7 ± 2.5 vs 2.3 ± 1.7 units/per patient, P = 0.611) and transfusion rates (22% vs 11%, P = 0.703).

Conclusion

An event-initiated, team-based response to an adverse bleeding event during laparoscopic HPB surgery correlates with positive effects on bleeding management, and transfusion rates.

中文翻译：

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腹腔镜肝胰胆管手术出血的战略反应：术中检查表

背景

目的是开发和测试事件发起的、基于团队的检查列表的效用，以优化腹腔镜 HPB 手术期间对出血的反应。

方法

为了建立管理出血事件的清单，我们进行了系统评价。使用名义组技术 (NGT)，开发了一个由四个域组成的清单。在对麻醉和手术人员进行团队培训后，实施了检查表。比较实施清单前后的 HPB 病例的不良结局、出血并发症和输血情况。

结果

NGT 确定了四个域：通信控制、暴露和修复，检查表是在这些域下组织的。补充视频，详细了解如何将每个域应用于特定案例示例。我们将实施前的 169 例 HPB 病例与实施后的 53 例进行了比较。我们发现在实施检查表后进行的病例平均 EBL 显着下降（从 518 ± 852.8 到 151.5 ± 221.7 ml ( P  = 0.001)），并且 pRBC 输注量呈减少趋势（2.7 ± 2.5 vs 2.3 ± 1.7 个单位/每位患者，P  = 0.611）和输血率（22% vs 11%，P  = 0.703）。

结论

在腹腔镜 HPB 手术期间，对不良出血事件的事件发起、基于团队的反应与对出血管理和输血率的积极影响相关。