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Principles
ofPerioperative
Safety and Eciency
JamalJ.Hoballah
HaythamM.A.Kaafarani
GeorgiosTsoulfas
Editors
123
Principles of Perioperative Safety
andEciency
Jamal J. Hoballah • Haytham M. A. Kaafarani
Georgios Tsoulfas
Editors
Principles of Perioperative
Safety and Eciency
Editors
Jamal J. Hoballah
Surgery
American University of Beirut
Medical Center
Beirut, Lebanon
Georgios Tsoulfas
Transplantation Surgery
Aristotle University School of Medicine
Thessaloniki, Greece
Haytham M. A. Kaafarani
Surgery
Massachusetts General Hospital
Boston, MA, USA
ISBN 978-3-031-41088-8 ISBN 978-3-031-41089-5 (eBook)
https://doi.org/10.1007/978-3-031-41089-5
© Springer Nature Switzerland AG 2024
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microlms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
We dedicate this textbook to our patients, to
https://t.me/med1917
whom we pledge every day to provide with
the safest and highest quality care
that we can.
Foreword
https://t.me/med1917
It gives me great pleasure to write this foreword to Principles of Perioperative
Safety and Efciency, as this text represents many different elements of the surgical
experience. This is a tremendous example of the remarkable success of the Dr. Pon
Fund International Chapter Opportunity program, which is named for Pon
Satitpunwaycha, MD, FACS, whose generous donation through the American
College of Surgeons (ACS) International Relations Committee has sponsored educational courses by ACS chapters around the world. The textbook is based on the
“Principles of Perioperative Safety and Efciency” course, which was offered in
July 2018in Beirut, Lebanon, by the Lebanese ACS Chapter, supported by a Dr.
Pon Fund award. The enthusiastic participation in that course highlighted the need
to address, safeguard, and promote principles of perioperative safety and efciency.
The entire perioperative process impacts successful surgical outcomes.
Despite various national and global safety initiatives, perioperative adverse
events remain alarmingly high, and this is especially notable in hospitals in low- and
middle-income countries, which may lack the resources to address the factors leading to untoward events. This textbook aims to teach healthcare providers the fundamental standards of perioperative safety and efciency. This text is appropriate not
only for surgeons, but also for anesthesiologists, residents of many specialties,
medical students, nurses, hospital administrators, and other members of the healthcare team. Many will derive benet from multiple chapters, including those focused
on informed consent in the digital era, cost containment, checklists, medication
errors, management of challenging patients, surgical site infections, handling of
specimens, error reporting, and data-driven safety and quality measurements.
In my role at the ACS, I continue to focus on our 110-year-old motto, “To Heal
All with Skill and Trust.” The principles espoused in this text are central to our mission. I am pleased at the collaborative approach taken by surgeons around the world
to advance ACS initiatives and improve the care of all our patients.
Finally, I would like to extend my congratulations to Jamal J. Hoballah, MD,
MBA, FACS; Haytham M. A. Kaafarani, MD, MPH, FACS; and Georgios Tsoulfas,
MD, PhD, FACS for their efforts in the coordination and collaboration necessary to
convene these extraordinary surgeon authors. Moreover, I thank each of them for
their commitment to the International Relations Committee of the ACS, each having
served in leadership roles.
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Foreword
I am condent that this text will be a valuable resource to surgeons and healthcare workers in all practice settings.
American College of Surgeons PatriciaL.Turner
Chicago, IL, USA
Preface
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“You must know, my pupils, that operative surgery is divided into two parts: one where the
operation is performed safely, and one, on the other hand, where lethal complications arise.”
Albucasis, 1000 AD, On Surgery & Surgical Instruments
Surgery is a high-hazard eld. Despite all the technological advances, perioperative mortality and morbidity rates remain high. Despite decades of the patient safety
movement, wrong-site surgery still happens. Despite awareness, surgical res and
intraoperative deaths still occur. The journey toward zero preventable harm to surgical patients is long but worthwhile.
It is with great pride that we bring you the rst perioperative safety textbook. The
textbook is comprehensive, covering multiple areas of safety and quality of the surgical patient, from preoperative to intraoperative and postoperative care. In this textbook, experts in surgical, medical, and anesthesia safety have come together to
bring you the latest in safety science and the latest evidence in high-reliability science and have applied it to surgery in order to ensure surgical patients always
receive the highest quality and safest care possible.
We hope this textbook serves as a valuable reference to the millions of nurses,
physicians, administrators, and healthcare providers who have dedicated their lives
to safeguarding surgical patients worldwide.
Beirut, Lebanon JamalJ.Hoballah
Thessaloniki, Greece GeorgiosTsoulfas
Boston, USA HaythamM.A.Kaafarani
ix
Contents
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Part I Perioperative Optimization
1 Human Factors and Principles of Patient Safety:
The James Reason Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Ryan Howard and Justin B. Dimick
2 Preoperative Testing in the Era of Cost Containment:
Is There a Limit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Georgios Tsoulfas
3 Preventing Never Events: Checklists, Timeouts, Debriefings,
and Skin Marking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
George Molina and Alex Haynes
4 Reducing Perioperative Medication Errors: How to Build Safer
Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Petra Khoury and Ulfat Usta
5 Managing the Patient on Antiplatelet, Anticoagulation,
Beta Blockers, Angiotensin-Converting Enzyme Inhibitors,
Angiotensin-Receptors Blockers: The Anesthesia Perspective
Cynthia Karam, Wissam Maroun, and Marie T. Aouad
6 Reducing Surgical Site Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Kamal M. F. Itani and Gentian Kristo
7 Perioperative Deep Vein Thrombosis Prophylaxis . . . . . . . . . . . . . . . . . 103
Mohammad Rachad Wehbe, Charbel F. Matar, Ali Taher,
and Jamal J. Hoballah
8 Handling Pacemakers and Implantable Cardioverter
Defibrillators in the Operating Room . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Mohammad Sabra and Marwan M. Refaat
9 Traffic, Attire, and Distractions in the Operating Room . . . . . . . . . . . 133
Chrysanthos D. Christou, Jamal J. Hoballah, and Georgios Tsoulfas
10 Handling Surgical Specimens to Decrease Errors in Pathology . . . . . . 155
Fouad Boulos and Michel Attieh
. . . . . . . 69
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Contents
11 Blood Transfusion Safety in the Operating Room . . . . . . . . . . . . . . . . . 169
Nathan D. Neilsen, Roman Dudaryk, and Daniel Dante Yeh
Part II System Design and Improvement
12 Detecting and Reporting Errors, Complications,
and Adverse Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Majed El Hechi and Haytham M. A. Kaafarani
13 Simulation Technical Training to Improve Safety in the OR . . . . . . . . 217
Rana M. Higgins and Marc A. de Moya
14 Teamwork and Communication Simulation to
Improve Safety in the OR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Jamie L. Sparling and Jeffrey B. Cooper
15 Implementing Crew Resources Management
Principles to Improve Perioperative Safety . . . . . . . . . . . . . . . . . . . . . . 251
Abdulelah Alhawsawi and M. Soa Macedo
16 Peer Review of Perioperative Adverse Events . . . . . . . . . . . . . . . . . . . . 269
Lydia R. Maurer, Elizabeth Mort, and Haytham M. A. Kaafarani
17 Enhanced Recovery After Surgery Protocols . . . . . . . . . . . . . . . . . . . . . 277
Timothy E. Newhook and Thomas A. Aloia
18 “I Can’t Ventilate!” Intraoperative Anesthesia Safety
Events and Airway Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Marwan Sarkis Rizk, Sarada Eleswarpu, and Chakib Maurice Ayoub
19 “Don’t Yell at Me!” Disruptive Behavior in the OR . . . . . . . . . . . . . . . 315
Julia R. Coleman and Richard Schulick
20 “Code Red!” Preventing and Managing Fire and Smoke
Hazards in the OR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Wilton C. Levine and Yasmine Tameze
21 “I Got Stuck!” Blood Exposure in the OR:
Prevention and Management of Sharp Injuries
and Infectious Disease Exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Tala Ballouz, Carine Sakr, and Nesrine A. Rizk
22 “I’m Missing a Sponge!” New Techniques in the
Prevention of Foreign Body Retention . . . . . . . . . . . . . . . . . . . . . . . . . . 357
Scott E. Regenbogen and Samantha J. Rivard
23 Principles of Perioperative Safety and Quality on the Global Stage . . 371
Meena Nathan Cherian, Jyotsna Agarwal, Raymond R. Price,
Janet Martin, Adrian W. Gelb, and Davy Cheng
24 The Role of the American College of Surgeons in Advancing
Perioperative Safety and Efficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Julia R. Coleman and Patricia L. Turner
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407
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