ArticleBMC surgery2025
Deciphering near-miss events in paediatric laparoscopic fundoplication: a video-based analysis of mechanisms and consequences.
Article in BMC surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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4 authors.
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Abstract
backgroundNear-miss events during paediatric laparoscopic fundoplication can affect surgical efficiency. This study aimed to classify near-miss events using the Generic Error Rating Tool (GERT) and evaluate their impact on procedure time.
methodsA retrospective review of surgical videos and medical records was conducted for patients who underwent laparoscopic fundoplication between 2015 and 2024. The near-miss events were identified and categorised by two paediatric surgeons using the GERT. Inter-rater reliability was assessed using Cohen's κ. The frequency and distribution of near-miss events were analysed across surgical steps, and the association between the number of near-miss events and procedure time was evaluated using multivariate linear regression analysis.
resultsThirty-eight patients were included, and 170 near-miss events were identified. The most common events were bleeding or haematoma (n = 87, 51.2%), followed by thermal injury (n = 40, 23.5%) and entangled or broken sutures (n = 23, 13.5%). Events occurred most frequently during the surgical exposure of the diaphragmatic crura and oesophageal encirclement (n = 65, 38.2%). Rectification measures were required in 14.1% of events, with a median intervention time of 66.5 s. Inter-rater agreement for event classification was substantial (Cohen's κ = 0.83, p < 0.001). A moderate positive correlation was observed between the number of near-miss events and procedure time (Spearman's r = 0.43, p = 0.0072). Furthermore, multivariate linear regression analysis demonstrated a significant association between the number of near-miss events and prolonged procedure time (regression coefficient = 7.28, 95% confidence interval: 1.49-13.06, p = 0.015).
conclusionsThese findings indicate that near-miss events are significantly associated with longer procedure times in paediatric laparoscopic fundoplication. The application of the GERT offers a robust framework for understanding these errors and holds potential for enhancing surgical training. Addressing and mitigating such events may contribute to optimising surgical efficiency and improving patient safety.
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