Global Veterinary Surgery

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Surgery checklists in veterinary medicine serve as invaluable tools for ensuring the safety and success of surgical procedures. Modeled after the World Health Organization’s human surgical safety checklist, these protocols have been adapted to meet the specific needs of veterinary practices. They are designed to standardize and streamline pre-operative, intra-operative, and post-operative procedures.

The checklist process typically begins in the pre-operative phase. This involves confirming essential details such as patient identification, procedure to be performed, and site of surgery. It also ensures that relevant diagnostic tests and imaging have been conducted. This step is crucial in preventing errors due to miscommunication or oversight.

During the intra-operative phase, the checklist plays a pivotal role in maintaining a sterile environment and verifying that all necessary equipment and supplies are readily available. It prompts a review of critical information, such as the patient’s position, surgical site preparation, and administration of anesthesia. This stage is vital in minimizing risks associated with anesthesia and preventing surgical site infections.

Additionally, the checklist aids in confirming the surgical team’s roles and responsibilities. This collaborative approach fosters clear communication among team members, reducing the likelihood of missteps and enhancing overall efficiency. The importance of this aspect cannot be overstated, as a well-coordinated team is instrumental in achieving optimal surgical outcomes.

Post-operatively, the checklist ensures that all necessary steps are taken to monitor the patient’s recovery and provide appropriate post-operative care. This includes verifying the accuracy of recorded details such as medications administered, surgical instruments accounted for, and any specific instructions for the patient’s aftercare.

Beyond the immediate benefits, surgery checklists have been shown to have a profound impact on patient safety and outcomes. Studies have demonstrated a significant reduction in surgical complications and mortality rates in practices that implement comprehensive checklists. Moreover, they contribute to a culture of accountability and continuous improvement within veterinary surgical teams.

Furthermore, the use of surgery checklists promotes compliance with regulatory and accreditation standards. Veterinary hospitals and clinics that adhere to established protocols demonstrate a commitment to the highest standards of care, which can enhance their reputation and instill confidence in clients.

While the adoption of surgery checklists in veterinary medicine has become increasingly widespread, challenges may still arise. Resistance to change, human error, and complacency can pose barriers to effective implementation. Therefore, ongoing training, education, and regular audits are essential to ensure consistent adherence to checklist protocols.

In conclusion, surgery checklists are indispensable tools in veterinary medicine, safeguarding the well-being of animal patients and enhancing the quality of care provided. By standardizing procedures, promoting communication, and reducing the likelihood of errors, these checklists play a vital role in elevating the standards of surgical practice in veterinary medicine. Their widespread adoption and vigilant implementation are pivotal in ensuring the continued advancement of veterinary surgical care.

On Wednesday of next week the WSAVA Oncology WorkingGroup will officially launch the Cancer Surgery Checklists. You can find it here:

And the Spanish and Portuguese translations:

Leon, Mexico, is a vibrant city in Guanajuato, known for its rich cultural heritage, industrial prowess, and warm hospitality. With a population of over a million, Leon is a bustling metropolis that combines history with modernity.

The CVDL Congress, or Congreso del Valle de México, is a significant annual event in Leon. It is a platform for various industries, including technology, manufacturing, and commerce, to converge and discuss cutting-edge developments and trends. This congress plays a pivotal role in shaping the region’s economic landscape.

I am very appreciative of the fantastic organizers, Dr. Cesar Morales, a great friend and visionary, and Jess, who always saves me from everything.

It is great also to meet many global friends, for instance, Rafael Laguens, the President of the World Veterinary Association (WVA). The WVA is a global organization that promotes animal health and welfare worldwide. Under Laguens’ leadership, the WVA likely continued to advocate for best practices in veterinary medicine and collaborate with professionals and organizations around the globe.

The following abstract was just submitted to the WSAVA 2023 World Congress and contains coll data from a study about a new surgery checklist in cancer cases.

Title: Enhancing Surgical Safety in Veterinary Medicine: The Importance of Surgery Checklists.

Introduction: Surgical procedures in veterinary medicine are intricate processes that demand meticulous coordination among the surgical team. Despite the significant risks involved, using surgery checklists in veterinary surgery remains uncommon. This lecture explores the importance of implementing surgery checklists in veterinary medicine, highlighting their benefits, the role of teamwork, the influence of the World Health Organization (WHO) guidelines, the structure of the checklist, and the impact of checklist implementation on veterinary professionals.

The Value of Surgery Checklists: Surgery is a collaborative effort that involves various professionals, including surgeons, anesthesia specialists, nurses, and technicians. The entire team should embrace surgery checklists to ensure a safe and efficient surgical environment. These checklists offer a systematic approach to enhancing patient safety by reducing the likelihood of errors, complications, and avoidable risks.

The Influence of the World Health Organization: The World Health Organization’s “Safe Surgery Saves Lives” initiative has pioneered surgery checklists as a vital tool to improve patient outcomes. While initially developed for human surgery, the principles apply equally to veterinary medicine. This initiative emphasizes the need for adherence to essential safety steps that minimize common and preventable surgical risks.

Structure of the Surgery Checklist: The surgery checklist, designed to be concise and straightforward, divides the surgical procedure into four phases, each corresponding to a specific time period in the surgical workflow:

1. Sign In: Before induction of anesthesia

2. Move-In: Before patient movement in the operating room

3. Time Out: Before surgical incision

4. Sign Out: During or after wound closure but before patient removal from the operating room

Each phase involves a checklist coordinator who verifies the completion of tasks before progressing to the next stage. This structured approach ensures that critical safety steps are consistently followed.

Benefits of Checklist Implementation: A survey of veterinary professionals (VSSO listserve) revealed that a significant percentage (67%, n= 48) already used surgery checklists, while others had not adopted this practice. However, we observed that many of the individual steps in the checklist were already considered routine in facilities globally, albeit often not followed comprehensively. This underscores the need for implementing surgery checklists to ensure consistency and adherence to these vital safety measures.

Impact on Veterinary Professionals: The follow-up survey results provide insights into the impact of checklist implementation on veterinary professionals. The findings suggest that surgery checklists improve communication, reduce work pressure, enhance teamwork, and better training. Most professionals felt comfortable asking questions when something was amiss and believed that patient care information was communicated effectively. However, there were still concerns about missing critical information when needed, indicating room for improvement. Moreover, the survey revealed that teamwork and training improved after checklist implementation, with a substantial percentage feeling that their facility did a good job communicating information affecting patient care. Issues such as feeling rushed while caring for patients, and the adequacy of orientation and refresher training for new staff require attention.

Conclusion: In conclusion, implementing surgery checklists in veterinary medicine ensures patient safety and minimizes avoidable risks. The World Health Organization’s emphasis on safe surgery has paved the way for adopting surgery checklists, which offer a structured approach to enhancing communication, teamwork, and training among veterinary professionals. The survey results underscore the benefits of checklist implementation while highlighting areas requiring further attention. As the WSAVA Oncology Working Group prepares to launch the WoW Cancer Surgery Checklist, the veterinary community can enhance surgical safety and patient outcomes through comprehensive surgery checklists.

Table 1 Survey with 48 veterinary surgery professionals (through the VSSO listserve)

I use a surgery checklist	67%
I encountered a near-miss event in my clinic	52%
I use MMM rounds in my clinic	44%
Patient care info is clearly communicated	53%
I feel comfortable asking questions when something is not right	70%
We have enough staff to handle the workload	53%
Key information is missing when it is needed	34%
We do a good job communicating information that affects patient care	90%
We feel rushed when taking care of patients	76%
Staff who are new to us receive adequate orientation	50%
Staff get the refresher training they need	40%
We work together as an effective team	80%
Staff are treated fairly when they make mistakes	85%
We make improvements when someone points out safety problems	87%
We are good at changing processes to make sure the same patient safety problems do not happen again	72%
We encourage everyone to suggest ways to improve patient safety	75%
We examine near-miss events that could have harmed patients but did not	50%
We provide adequate resources to improve patient safety	64%

Table 2. A follow-up survey with 13 veterinary surgery professionals about use of the WoW Cancer Surgery Checklist in their clinic.

We used the checklist	85%
We gave the checklist between 3-5 (5 is best) score	90%
We explained the checklist to our staff	46%
We had a near-miss event during the test period	14%
The checklist improved the clear communication of important patient care info	46%
The checklist allows to share key information about our patients as soon as it becomes available	60%
The checklist allows you to do a good job communicating information that affects patient care	70%
I feel rushed when taking care of patients	30%
Staff who are new to this facility receive adequate orientation	70%
The checklist allows us to share key information about our patients as soon as it becomes available	30%
The checklist improved patient safety	77%
We are treated fairly when you make mistakes	85%
The checklist leads to improvements when someone points out safety problems	45%
The checklist helps at changing processes to make sure the same patient safety problems do not happen again	39%
Our manager embraces the use of the checklist	60%
Management examines near-miss events that could have harmed patients	60%
Management provides adequate resources to improve patient safety	76%

Thyroid hyperplasia in cats, known as hyperthyroidism, is a common endocrine disorder. It occurs when the thyroid glands produce an excessive amount of thyroid hormones. This often results in an increase in metabolic rate and a range of symptoms, including weight loss despite increased appetite, restlessness, increased heart rate, vomiting, diarrhea, and sometimes changes in behavior. The exact cause of feline hyperthyroidism is not fully understood, but it’s thought to be related to changes in the thyroid gland’s structure. Most cases are caused by benign tumors called thyroid adenomas, which cause the thyroid gland to enlarge and overproduce hormones. In rare cases, thyroid carcinomas (malignant tumors) can also cause hyperthyroidism. Diagnosis is typically made through blood tests that measure the levels of thyroid hormones (T3 and T4).

Feline hyperthyroidism can be treated through various methods, depending on the cat’s age, overall health, and the preferences of both the cat owner and the veterinarian. Here are the common treatment options:

1. **Medication**: Anti-thyroid medications, such as methimazole or carbimazole, are commonly prescribed. These medications help to control the overproduction of thyroid hormones. However, they require ongoing administration and monitoring of thyroid levels.

2. **Radioactive Iodine Therapy**: This treatment involves administering a small, controlled amount of radioactive iodine, which selectively targets and destroys the overactive thyroid tissue. It’s considered a very effective treatment, often resulting in a permanent resolution of hyperthyroidism. Cats receiving this treatment are usually hospitalized briefly to ensure proper handling of radioactive material.

3. **Surgical Removal of the Thyroid Glands**: Surgical removal of the affected thyroid gland(s) can be an option, especially if only one gland is affected or the cat is not suitable for radioactive iodine treatment. However, surgery carries risks and may require life-long hormone supplementation if both glands are removed.

4. **Prescription Diet**: Some specialized diets (Hill’s Prescription Diet y/d) are formulated to manage hyperthyroidism. These diets are low in iodine, essential for thyroid hormone production. Restricting iodine intake reduces the thyroid’s ability to produce excess hormones.

Treatment choice depends on factors like the cat’s age, overall health, the severity of the hyperthyroidism, and the owner’s preferences. If left untreated, hyperthyroidism can lead to severe complications such as heart problems, kidney issues, and high blood pressure. Regular veterinary check-ups and early detection are important for managing this condition effectively.