OBJECTIVE

To provide a review of human factors research within the context of surgery. DATA SOURCES We searched PubMed for relevant studies published from the earliest available date through February 29, 2012. STUDY SELECTION The search was performed using the following keywords: human factors, surgery, errors, teamwork, communication, stress, disruptions, interventions, checklists, briefings, and training. Additional articles were identified by a manual search of the references from the key articles. As 2 human factors specialists, a senior clinician, and a junior clinician, we carefully selected the most appropriate exemplars of research findings with specific relevance to surgical error and safety. DATA EXTRACTION Seventy-seven articles of relevance were selected and reviewed in detail. Opinion pieces and editorials were disregarded; the focus was solely on articles based on empirical evidence, with a particular emphasis on prospectively designed studies. DATA SYNTHESIS The themes that emerged related to the development of human factors theories, the application of those theories within surgery, a specific interest in the concept of flow, and the theoretical basis and value of human-related interventions for improving safety and flow in surgery.

CONCLUSIONS

Despite increased awareness of safety, errors routinely continue to occur in surgical care. Disruptions in the flow of an operation, such as teamwork and communication failures, contribute significantly to such adverse events. While it is apparent that some incidence of human error is unavoidable, there is much evidence in medicine and other fields that systems can be better designed to prevent or detect errors before a patient is harmed. The complexity of factors leading to surgical errors requires collaborations between surgeons and human factors experts to carry out the proper prospective and observational studies. Only when we are guided by this valid and real-world data can useful interventions be identified and implemented.

OBJECTIVES

To describe the surgical oncology experience at a major regional hospital in Malawi and to identify barriers to improved outcomes. DESIGN Retrospective review of operating logbooks from a single tertiary referral center. SETTING Major tertiary referral center (Kamuzu Central Hospital) in Lilongwe, Malawi, in sub-Saharan Africa. PATIENTS Patients were identified with a suspected diagnosis of cancer from January 1, 2004, through March 7, 2007. MAIN OUTCOME MEASURES Cancer cases were classified according to patient demographic characteristics, disease location, and therapeutic intent. The Malawi data were compared with US data from the Surveillance Epidemiology and End Results database.

RESULTS

A malignant diagnosis was suspected in 255 of the 1440 patients undergoing a major resection (17.8%) (mean patient age, 53 years). The most common cancers in males were prostate, esophageal, and gastric. In females, the most common cancers were breast, colon, and esophageal. Many of the procedures were performed with palliative intent.

CONCLUSIONS

Cancer surgery comprises a significant proportion of the surgical caseload in low-income countries. Patients often present with late-stage, inoperable cancer. The participation of the surgical community is critical for addressing barriers to effective cancer care.

OBJECTIVE

To evaluate the effects of prior abdominal surgery and obesity and the level of spine exposure on the technical aspects and complications of anterior retroperitoneal exposure of the lumbar spine (ARES). DESIGN Retrospective review of prospective database. SETTING Academic vascular surgery practice. PATIENTS Patients undergoing ARES from 2001 to 2011. MAIN OUTCOME MEASURES Influence of prior abdominal surgery, obesity, and level of exposure on time to spine exposure and incidence of vascular and perioperative complications.

RESULTS

Four hundred seventy-six patients underwent ARES. Mean (SD) age was 47.7 (12.6) years; 46.6% had undergone prior abdominal surgery. Mean (SD) body mass index (BMI) was 28.3 (5.5); 61.6% of procedures included the L4-5 disk. Mean (SD) time to exposure was 70.0 (25.5) minutes. Vascular injury occurred in 23.3% (3.8% major). Perioperative complications occurred in 16.4% of cases. Prior abdominal surgery had no effect on time to exposure, vascular injury, and perioperative complications. A BMI of 30 or more had no effect on time to exposure compared with a lower BMI. A BMI of 30 or more led to higher rates of vascular injury (30.8% vs 19.7%; P = .007) and overall complications (21.4% vs 14.0%; P = .04). Exposures involving L4-5 led to increased time to exposure (77.0 vs 56.2 minutes; P < .001) and higher rates of vascular injury (29.7% vs 13.1%; P < .001) but had no effect on overall complications compared with exposures for other levels.

CONCLUSION

Prior abdominal surgery should not be considered a contraindication to ARES. Caution is warranted in obese patients and exposures involving L4-5.

OBJECTIVE

To examine the effect of previous sexual abuse or assault (SAA) on symptom severity, quality of life, and physiologic measures in women with fecal incontinence or constipation. DESIGN A cross-sectional study of a prospectively maintained clinical database. SETTING A tertiary referral center for evaluation and physiologic testing for pelvic floor disorders. PATIENTS Women with fecal incontinence or constipation examined during a 6-year period. MAIN OUTCOME MEASURES Symptom severity and quality of life were measured with the Fecal Incontinence Severity Index (FISI), Fecal Incontinence Quality of Life Scale (FIQL), Constipation Severity Instrument (CSI), Constipation-Related Quality of Life measure (CR-QOL), and 12-Item Short Form Health Survey (SF-12). Physiologic variables were ascertained with anorectal manometry, electromyography, and endoanal ultrasonography.

RESULTS

Of the 1781 women included, 213 (12.0%) reported SAA. These women were more likely to be white, to report a psychiatric illness, and to have a prior hysterectomy or episiotomy. On bivariate analysis, women with prior SAA had increased symptom severity on the FISI (P = .002) and CSI (P < .001) and diminished quality of life on the FIQL (P < .001), CR-QOL (P = .009), and SF-12 (P = .002 to P = .004). Physiologic variables did not differ significantly between patients with and without prior SAA.

CONCLUSIONS

A history of SAA significantly alters disease perception in fecal incontinence and constipation, but the disorders do not result from increased physiologic alterations. We must elicit a history of SAA in these patients, because the history may play a role in the discrepancy between symptom reporting and objective measurements and may modify treatment recommendations.