Objective To summarize the characteristics of surgery-related near misses including events composition, cause of incident, specialty category, personnel allocation etc, and to provide experience of feedforward control for the nurses in operating room and a clinical basis of safety standards for the management of operating rooms. Method The 240 surgery-related near misses occurred between July 2014 and July 2016 were retrospectively analyzed, using frequencies and percentiles to describe the count data. Results The 240 surgery-related near misses were mainly associated with surgical stitches (91 cases, 37.9%), surgical dressings (52 cases, 21.7%) and surgical instruments (45 cases, 18.8%). The main features of the 91 cases of surgical stitching included loss of suture needles (40.7%, 37/91) and fracture events (37.4%, 34/91). Among the 52 cases of surgical dressings, the most commonly were gauze dressing events (43 cases, 82.7%), in which 19 were with unclear numbers of retained gauzes in the reoperation patient’s body, and 15 were postoperative counting anomalies. Among the 45 cases of surgical instruments, the fracture and defect were the most common (21 cases, 46.7%). Conclusion The operation nurses should focus on the prevention of suture needle loss, the surgical dressings loss and the fracture and defect of surgical instruments, etc, to reduce or avoid the surgery-related near misses.
Objective To retrospectively analyze the analgesic effect and cost-effectiveness of combined analgesia versus intermittent analgesia for patients underwent retroperitoneal laparoscopic surgery. Methods We retrospectively collected clinical parameters and outcomes of analgesic effect from patients who underwent retroperitoneal laparoscopic surgery. Included patients were divided into two groups: local injection of ropivacaine combined with intermittent administration with analgesic via intravenous injection and intermittent administration with analgesic via intravenous injection only. Visual analogue scale (VAS) at different time points (2 h, 4 h, 6 h, 12 h, 24 h), usage of postoperative non-steroidal anti-inflammatory drugs (NSAIDs), adverse events, costs and other information were collected and assessed for further analysis of analgesic effect and cost-effectiveness. Results A total of 80 patients were enrolled in this study, each group consists of 40 patients. The results of this study found that VAS scores at 2 h and 4 h after operation in the combined analgesic group were significantly lower than that in the intermittent intravenous analgesia group (P<0.05), while there were no significant differences between the two groups in VAS scores at 6, 12 and 24 h after operation. The usage of NSAIDs were significantly lower in the combined group than intermittent group (P<0.05). The effective rate in the combined group was significantly higher than that in the intermittent group (P<0.05). The average cost of postoperative hospitalization and postoperative analgesic of the two groups were similar (allP values >0.05), and cost-effectiveness evaluation of the combined analgesia group was better than that of intermittent group. Conclusion Compared to intermittent administration with analgesic via intravenous injection, subcutaneous injection of ropivacaine hydrochloride combined with intermittent intravenous injection of parecoxib in patients underwent retroperitoneal laparoscopic surgery significantly could alleviate patients' painful complaints and reduce the postoperative usage of NSAIDs without increasing adverse events. Furthermore, the combination strategy has a lower cost-effectiveness ratio than intermittent group, which represents economic advantages.