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Perioperative management of positioning in gynecological cancersurgery: a national NOGGO-AGO intergroup survey
  1. Mareike Bommert1,2,
  2. Jenny Katharina Wagner2,3,
  3. Jalid Sehouli2,4,
  4. Alexander Burges5,
  5. Barbara Schmalfeld6,
  6. Hendrik Veldink2,7,
  7. Irmela Schrettenbrunner2,8,
  8. Markus Fleisch9,
  9. Rolf Richter4,
  10. Philipp Harter1 and
  11. Klaus Pietzner2,4
  1. 1 Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung Essen-Huttrop, Essen, Germany
  2. 2 Young Academy of Gynecologic Oncology (JAGO), Berlin, Germany
  3. 3 Department of Gynecology, Campus Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
  4. 4 Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
  5. 5 Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, University Hospital Munich Department of Gynecology and Obstetrics Grosshadern Campus, Munchen, Germany
  6. 6 Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  7. 7 Department of Obstetrics and Gynecology, Stiftung Mathias-Spital Rheine, Rheine, Germany
  8. 8 Department of Obstetrics and Gynecology, Sana Kliniken des Landkreises Cham GmbH, Cham, Germany
  9. 9 Department of Obstetrics and Gynecology, Helios University Medical Center Wuppertal, Wuppertal, Germany
  1. Correspondence to Dr Klaus Pietzner, Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin 10117, Germany; klaus.pietzner{at}charite.de

Abstract

Introduction The daily clinical routine in the operating room includes patient positioning. The number of perioperative positioning-related complications is growing, along with the legal proceedings concerning this topic, and only a few guidelines exist to provide specific recommendations. The aim of this survey was to assess perioperative positioning and associated adverse events during gynecological cancer surgery in Germany.

Methods A total of 633 gynecological departments of primary, secondary, and maximum healthcare hospitals in Germany were invited to participate in this multiple-choice online questionnaire. The survey was conducted anonymously for a period of six months. The survey was divided into five different sections: descriptive information about the respondent department, pre- and postoperative management, management of positioning in the operating room based on two fictional case examples, and quality management.

Results The response rate of our survey was 29.1 % (184/633). Nearly half of the departments (46.7 %) reported to have had one to five patients with positioning-related complications during the prior 12 months, and 29.1 % had experienced a legal dispute due to positioning-related complications. Departments with more than 50 gynecologic-oncological surgeries per year more often reported positioning-related complications (p=0.003). Standard operating procedures exist in almost every department for laparoscopic (97 %) and open surgery (95.1 %), respectively.

Discussion The high number of positioning-related complications throughout all departments of different healthcare levels underlines the relevance of this issue and supports the need for a prospective European registry for further analysis. Training and education for all staff members should be routinely implemented to reduce and prevent positioning-related complications.

  • gynecologic surgical procedures
  • postoperative complications
  • surgical oncology
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Footnotes

  • MB and JKW contributed equally.

  • Contributors MB and JKW share first authorship. Both authors contributed equally to this study. MB contributed substantially to data acquisition, data analysis and drafting of the manuscript. JKW contributed substantially to conception of the work, data acquisition, data analysis and drafting of the manuscript. JS contributed substantially to conception and design of the work, data interpretation and critical revision of the manuscript. AB contributed substantially to data interpretation and critical revision of the manuscript. BS contributed substantially to data interpretation and critical revision of the manuscript. HV contributed substantially to data acquisition. IS contributed substantially to data acquisition. MF contributed substantially to data interpretation and critical revision of the manuscript. RS contributed substantially to data analysis. PH contributed substantially to data interpretation and critical revision of the manuscript. KP contributed substantially to conception and design of the work, interpretation of data, drafting of the manuscript and critical revision of the manuscript. All authors gave final approval of the version published. All authors agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request from: klaus.pietzner@charite.de.

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