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Background The purpose of the current study was to explore the use of SBAR (Situation, Background, Assessment, Recommendation) for handoffs between surgical team members six years after implementation in a large academic tertiary care center. Methods Researchers observed 23 operative procedures for the presence of SBAR components (“S”,“B”,“A”,“R”) and the duration of handoffs by role type (circulating registered nurses (RN), certified surgical technicians (CST), certified surgical assistants/first assistants (CSA), and anesthesia team members(ANES)). Handoffs by role were further investigated between the giver and receiver of information defined as “personnel-change”. Inter-rater reliability, descriptive statistics, ANOVA, Kruskal-Wallis tests and appropriate post hoc tests were employed. Results Overall, of 119 handoffs observed, each on average addressed 67% of the four possible components. Specifically, 90% included component “S”, 58% included “B”, 64% included “A” and 55% included “R”. The frequency of SBAR components used differed by role type, (ANES included components “B”, “A” and more factors in total than CSA), as well as the duration of each handoff (ANES handoffs were longer than CST and CSA). Frequency of components used also differed significantly by personnel-change type (handoffs from original members to relief included significantly more SBAR components). Conclusion Findings suggest that while handoffs included most of the four SBAR factors, each varied by role type as well as personnel-change type involved. While SBAR has been implemented in several healthcare organizations, it may not be a “one-size fits all” model for all involved in the transfer of information and responsibility of care intraoperatively.

Background: Gangrenous cholecystitis is a severe form of acute cholecystitis with high morbidity. This study investigate the outcomes for patients undergoing cholecystectomy for gangrenous cholecystitis in the decade before and after the introduction of laparoscopic technology at our institution. Methods: From 1982 to 2002, all patients undergoing cholecystectomy for gangrenous cholecystitis were prospectively entered into a database. Demographic data, method of surgery, and outcome variables were assessed and compared over time. Results: Cholecystectomy was performed to treat gangrenous cholecystitis in 238 patients (mean age, 54 years). From 1982 to 1992, 98 patients underwent cholecystectomy for gangrenous cholecystitis, and from 1992 to 2002, 140 patients underwent the procedure. Ninety-seven patients underwent laparoscopic cholecystectomy, and 33 patients (34%) required conversion. The open and laparoscopic cholecystectomy group differed in the number of intensive care unit admissions (13% vs. 5%, P

Objective: Laparoscopic repair of ventral incisional hernias is feasible and safe. Polypropylene mesh is often preferred because of its ease of handling and lower cost. Complications like adhesion and fistula formation can occur. The goal of this study was to determine whether bowel adhesions and their attendant complications could be prevented by interposition of omentum. Methods: Thirty patients underwent laparoscopic ventral incisional hernias repair with polypropylene mesh. Omentum was always positioned over the loops of bowel for protection. At a mean follow-up of 14 months, 20 patients underwent ultrasonic examination using the previously described visceral slide technique to detect adhesions. Results: The mean size of the hernias in the study was 50.3 cm2, and the mean size of the mesh applied was 275 cm2. Thirteen patents (65%) had no sonographically detectable adhesions. Five patients demonstrated adhesions between the mesh and omentum, 1 patient developed adhesions between the left lobe of the liver and the mesh, and only 1 case of bowel adhesion to the edge of the mesh was found. Conclusion: Laparoscopic ventral incisional hernias repair with polypropylene mesh and omental interposition is not associated with visceral adhesions in the majority of patients. Polypropylene mesh can be used safely when adequate omental coverage is available.