Surgical never events, including wrong-site surgery, retained foreign objects, and wrong implants or prostheses, persist globally despite successive patient safety frameworks. Human factors are consistently identified as contributors, yet prior systematic reviews have not applied a structured health care-specific analytical taxonomy to this evidence base. This two-phase updated systematic review searched MEDLINE, CINAHL, and specialist journals from inception to December 2025, identifying 39 studies. Human factors findings were mapped against the five domains of the SHEEP model (Systems, Human Interaction, Equipment, Environment, Personal). Human Interaction and Systems were the dominant domains, co-occurring in the majority of studies. Equipment was the least prevalent domain, indicating that technology remains an adjunct rather than a primary prevention strategy. Sustained reduction in surgical never events requires investment in checklist fidelity, speaking-up culture, and organisational responses that prioritise learning over blame rather than reliance on guidance alone.Summary of Major ThemeSurgical never events, including wrong-site surgery, retained foreign objects, and wrong implants or prostheses, represent a persistent patient safety challenge despite successive national and international policy frameworks. Human factors are consistently identified as contributory across the published literature, yet no prior systematic review has applied a structured health care-specific analytical taxonomy to this evidence base. This two-phase updated systematic review applied the Systems, Human Interaction, Equipment, Environment and Personal (SHEEP) model across 39 included studies spanning inception to December 2025, producing domain-level frequency data unavailable from prior narrative reviews. Human Interaction and Systems were identified as the dominant domains, co-occurring in 77% of studies, confirming that never events arise from the simultaneous breakdown of communication and organisational safety systems rather than from isolated individual failures. Equipment was the least prevalent domain, indicating that technology-based prevention strategies remain an adjunct to cultural and systems change.

Fascia iliaca block is recommended as part of multimodal analgesia for patients with hip fracture, but early delivery and timestamped documentation are difficult to confirm in routine practice. This retrospective clinical audit assessed whether early delivery could be demonstrated from routine documentation in an operative hip-fracture pathway. The primary audit measure was fascia iliaca block documented within 2 h of emergency department arrival; exploratory outcomes included 48-h oral morphine equivalent dose, postoperative delirium, 30-day mortality and length of stay. Of 204 analysable episodes, 13 (6.4%; 95% confidence interval 3.8% to 10.6%) had fascia iliaca block documented within 2 h. A further 155 of 359 cleaned operative episodes (43.2%) had no recorded fascia iliaca block timing category. Exploratory outcome comparisons were underpowered because the early-delivery group was small. The findings identify a practical perioperative documentation and pathway gap requiring targeted improvement, mandatory timestamped recording and repeat audit.

Acquired haemophilia A is a severe and rare coagulation disorder caused by autoantibodies (inhibitors) against factor VIII. We present a case of acquired haemophilia A diagnosed during preoperative evaluation for lung tumour resection. Laboratory evaluation showed prolonged activated partial thromboplastin time (aPTT), reduced factor VIII activity, and detectable factor VIII inhibitors. Immunosuppressive therapy with oral prednisone led to normalisation of coagulation parameters and elimination of factor VIII inhibitors within 4 weeks. Surgical resection was performed without haemorrhagic complications. This case highlights the importance of early diagnosis and timely intervention in acquired haemophilia A to enhance clinical outcomes and mitigate the risk of haemorrhagic complications. Late identification of the disorder can have potentially catastrophic consequences in patients undergoing thoracic surgery.

Intraoperative hypotension (IOH) has traditionally been regarded as a transient and largely reversible physiological disturbance inherent to the administration of general and regional anaesthesia. However, contemporary perioperative outcomes research consistently suggests that IOH behaves not as a binary, threshold-based phenomenon, but rather as a duration-dependent ischaemic exposure affecting vulnerable end-organs. This manuscript argues that IOH should be reframed as a perioperative type-2 ischaemic syndrome, rather than being treated merely as an expected haemodynamic variable that is easily corrected with fluid boluses or intermittent sympathomimetic administration. Rather than targeting historically derived universal mean arterial pressure (MAP) thresholds alone, perioperative teams should adopt a holistic myocardial-protection framework incorporating MAP, systolic pressure, diastolic pressure, pulse pressure, and markers of organ perfusion. This framework must be grounded in an understanding of the patient's specific baseline perfusion pressure, an avoidance of cumulative hypotensive burden, and the judicious implementation of titrated vasopressor therapy alongside optimisation of preload, contractility, and tissue perfusion. This reconceptualisation has important implications for intraoperative anaesthetic management, postoperative biomarker surveillance, and the design of interdisciplinary, patient-centred perioperative care pathways.

Current surgical literature on wound healing often excludes immunosuppressed individuals, such as those with HIV, due to their clinical complexity. Underlying disease processes can negatively influence perioperative outcomes through prolonged wound healing and increased infection risk. This review summarises factors that influence wound healing in patients with HIV undergoing orthopaedic surgery and highlights literature gaps in HIV-specific outcomes that inform intervention timing, duration, and surveillance.

Atrial myxomas are uncommon primary cardiac tumours, often detected incidentally. Their presence poses significant anaesthetic challenges during non-cardiac surgeries, especially emergencies, due to the risk of obstructive haemodynamics and embolic phenomena. We report the successful perioperative management of a 69-year-old male with an incidentally diagnosed left atrial myxoma posted for emergency orthopaedic surgery following trauma. With meticulous planning, vigilant monitoring, and tailored anaesthetic strategies focusing on preload optimisation and rhythm stability, the surgery was completed uneventfully. This case highlights key perioperative considerations for clinicians managing similar high-risk patients.