Efficacy of a video refresher surgical technical assistance tool on surgeon performance of fasciotomies and proximal vascular control.

Background: Exsanguinating hemorrhage is the leading cause of death in combat casualty care. With improvement in body armor, risk for extremity injuries is increasingly making surgical control of vessels and extremity fasciotomies critically important for saving life and/or limb. Yet, surgeon hands-on experience with major trauma has decreased. In military settings, with limited surgical resources, surgeons could be required to work independently and outside their scope of expertise. We explored whether just-in-time skill refreshment with video review improves performance of selected procedures. Methods: Surgeons (n=44) performed upper and lower extremity fasciotomies and axillary and femoral artery exposures on anatomic donors. They were divided into two groups: one group received Surgical Technical Assistance Tool (STAT) video procedure assistance and the other received no assistance (control group). Performance was evaluated using a five-component (anatomy, pathophysiology, patient management, technical skills, and procedural) Individual Procedure Score (IPS). The total number of compartment decompressions/constriction releases (maximum 10, combined fasciotomy procedures) and number of vessels controlled (maximum of four, combined vascular procedures) were measured. Each compartment decompression/constriction release and each vessel controlled are also single data points within the IPS. Results: In combined fasciotomies, STAT significantly improved the number of successful compartment decompressions/constriction releases as well as procedural, anatomy, and technical IPS components. In combined vascular procedures, STAT improved anatomy IPS, but not the number of vessels successfully controlled. For successful compartment decompression/constriction release, there was a significant linear correlation with procedural, anatomy, and technical IPS components. For successful vascular control, there was a significant linear correlation with procedural and technical IPS components. There was no correlation between success and pathophysiology or patient management scores. Conclusion: A video-based, just-in-time refresher tool can dramatically improve procedural success and performance scores in procedural, anatomy, and technical components during trauma-related extremity procedures. Level of evidence: Level II, Original Research, Therapeutic/Care Management.