Do We Need a “Digital Safety Net”​ for Surgery?

By Björn von Siemens, contributing author Prof. Eric Vibert, MD, PhD

The operating room is a place where millions of lives are saved and improved each year. But it is also a place where nightmares occur. In fact, statistically speaking, it is one of the most dangerous places on earth: of the 313 million surgeries that take place worldwide each year, complications occur in 5.3% of the cases and postoperative deaths account for 7.7% of all deaths worldwide. In Germany, 31.8% of all reported medical errors stem from surgeries.

These errors are not only a psychological burden and source of stress for surgical teams, but also harm the trust between patient and surgeon. For hospitals, they result in costly reoperations and litigations that can drag on for months or even years. The problem is global—in South Korea, the government recently mandated cameras in operating rooms because of deathly errors and legal cases.

Yet, 50% of all complications in the operating room could be prevented. This is something that my co-author, Dr. Eric Vibert and myself have respectively spent many years trying to understand. If so many errors can be prevented, why do so many mistakes happen? Is it the fault of our medical staff or even surgeon arrogance?

The answer is, in the vast majority of cases, no. Instead, we would argue that the real issue is a lack of funding for and piecemeal methodological deployment of measures that could truly transform the operating room.

Why are Medical Errors Still Happening?

Let’s take a step back and look at the structural, organizational, and technological stressors that surgeons face. Surgeons work in highly stressful environments: Patient lives are at stake, technologies are constantly evolving, team members are changing or missing. Up to 9.9 million medical workers could be missing until 2030, even though, in the European region for example, the number of medical staff has increased by approximately 10% over the past 10 years (WHO, 2021).

Consequently, surgeons have less time for each patient to spare while the patient backlog is growing. In addition, huge amounts of data sources account for increasingly complex treatments and circumstances to be considered. These challenges have been exacerbated by the COVID-19 pandemic through additional workloads and volatilities: in April 2020, surgical volumes in the US were reduced by 59%, whilst 80% of resident training in the US was disrupted during the crisis. As a result of severe staff shortage, some US states declared an emergency in September 2021 and hospitals had to start turning away patients.

Despite this, there continues to be little support or automation—many systems and procedures have largely stayed the same for years. As a direct comparison, airplanes, also operated by highly skilled people working long shifts with the lives of many people in their hands, are extremely safe. Increases in automation and technological progress to support pilots in their work have advanced aircrafts to be among the safest places on earth.

We strongly believe that surgeons and their teams also need support to help them in their day-to-day jobs. What we need is more awareness of their challenges, public commitment to change and financial investments in tools and support systems on a hospital, regulatory and team level.

A Digital Safety Net to Change (and Save) Lives

As Dr. Vibert and his colleagues from the “Augmented Operating Room” Innovation Chair point out, many things could be done to improve patient outcomes in the operating room, ranging from tools for advanced surgical precision to the communication between surgeon and patient or room lighting.

But what our experience and research have taught us is that one of the most impactful changes is the implementation of digital tools in the operating room. New applications are changing the way surgical workflows are performed, analyzed, and learned from: a digital safety net for surgery.

Building such a safety net is exactly what Caresyntax is doing: the platform supports surgeons and their teams during procedures and gathers novel data that is available for review and development of applications. This means risks can be prevented before they occur—there is guidance from one surgical step to the next, automated warning systems stop common mistakes in certain procedures and post-surgery video-based assessments (VBA) encourage increased awareness and promote learning.

By creating an environment that provides healthcare professionals with guidance and VBA awareness tools, many benefits arise to help develop and optimize procedures to keep patients and surgeons safe:

• Surgeons are guided in critical situations and can easily identify and correct errors to specific actions. This leads to significantly improved surgeon skills as shown by e.g. University of Strasbourg.
• Furthermore, due to more efficient and faster procedures, patients are exposed to significantly reduced X-RAY time, as well as have less risk of catching dangerous surgical side infections (SSI).
• Surgeons can rewatch and examine footage, contributing to organizational and individual learning, whilst hospitals can automatically review practices as shown by e.g. Inselspital Bern.

Across the more than 4,000 operating rooms worldwide that use digital surgery solutions, located in UC San Diego, Sheba Medical Israel, University Hospital of Strasbourg and Charité Universitätsmedizin Berlin to name only a few, we have observed measurably better patient outcomes, better clinical team skills and more effective surgeries. There were lower complication rates, operating times and readmission rates among patients that have been treated with Caresyntax or similar digital platforms inside the operating room and fewer visits to the emergency department have been recorded.

Also, Caresyntax’s customers work more efficiently in uncertain environments: Performing on average 1.5 more surgeries per day and during COVID-19, Caresyntax retained 16% more surgical caseload for customer clinics.

In conclusion, human mistakes are bound to happen in high-intensity environments. To help surgeons practice at the top of their capabilities and minimize risks, health systems must reduce the structural, organizational, and technological stressors they face and invest in tools to support, monitor and assess performance on hospital, regulatory and team levels.

Improving patient outcomes in the operating room and supporting surgeons in their life-saving work is possible, it just needs the right amount of attention and resources. That is why we are both giving it our all to change this.

We’re excited to see what lies ahead of us, so please continue to follow us on our journey to the future of surgery!

More information on the initiatives:

• www.chaire-bopa.fr
• www.caresyntax.com

More information about contributing author: 

Prof. Eric Vibert, MD, Ph.D., is a 51-year-old academic surgeon at AP-HP who specialized in liver surgery and transplantation at Paul Brousse Hospital, Villejuif, where he works since 2007. He attended more than 130 International Congress Communication and 30 invited plenary conferences internationally. With an H-index of 43, he had 212 publications on liver diseases (27 in 2021), 27 as the first author, and 40 as of the last author (See https://www.ncbi.nlm.nih.gov/pubmed/?term=vibert+e). He graduated in Innovative treatment of post-hepatectomy liver failure, U-PSUD in 2012, when he also received his habilitation to direct research. E. Vibert is currently a full Professor PU-PH and researcher in surgical innovation (Paris Saclay Univ and INSERM U1193), connecting people arising from different worlds, especially engineers and surgeons to reinvent practices in surgery. Since 2019, he is chairman of a large consortium including Paris-Saclay Université, Mines-Telecom School and AP-HP called BOPA for the enhanced Operating room ((www.chaire-bopa.fr) that involves surgeons, anesthesiologists, surgical nurses, mathematicians, engineers, and anthropologists to improve safety in the operating room. BOPA is a large public/private consortium that is funded by 2 Foundations using an important financial sponsorship from Orange, Medtronics, Relyens, Boston Scientific Foundation, Richard Wolf, Getinge, Caresyntax, and Capgemini. He is the author of the book “Droit à l’Erreur, Devoir de Transparence” Ed Observatoire. Paris 2021.

Sources:

• Cha (2021, 31. August). South Korean lawmakers mandate cameras in operating rooms after surgery deaths. Reuters.
• Eappen, Lane, Rosenberg et al., (2013). Relationship between occurrence of surgical complications and hospital finances. JAMA.
• Harte, Bernstein (2021, 18. September). Some U.S. hospitals forced to ration care amid staffing shortages, COVID-19 surge. Reuters.
• Healy, Shackford, Osler et al., (2002). Complications in surgical patients. Arch Surg.
• Meara, Leather, Hagander et al., (2015). Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet.
• Nepogodiev, Martin, Biccard et al., (2019). Global burden of postoperative death. The Lancet.
• New York State, (2021, 27. September). No. 4: Declaring a Statewide Disaster Emergency Due to Healthcare Staffing Shortages in the State of New York.
• Ostapenko, McPeck, Liechty et al., (2020). Has COVId-19 hurt resident education? A network-wide resident survey on education and experience during the pandemic. Sage Journals.
• Paris-Saclay University, AP-HP Foundation, Institut Mindes-Télécom, (2021). “Augmented Operating Room” Innovation Chair: Improving practices in the operating room through innovative digital technologies.
• World Health Organization, (2021). Data and statistics, Health Workforce.