Management of Surgical Instruments in Geriatric Patients Undergoing Decompressive Craniectomy: A Case Report
DOI:
https://doi.org/10.53713/htechj.v4i3.423Keywords:
elderly, decompressive craniectomy, instrument management, patient safety, surgical checklistAbstract
Ensuring the safety of elderly patients undergoing decompressive craniectomy is crucial due to the high risk of complications resulting from surgical instrument mismanagement. This study aims to evaluate instrument management in elderly patients through a single case study approach. The method involved direct observation and interviews with the medical team during the surgical procedure, focusing on the implementation of the surgical safety checklist. The findings indicate that thorough verification, supervision, and documentation of instruments before, during, and after surgery play a significant role in preventing medical errors, improving surgical team efficiency, and accelerating patient recovery. The study concludes that the structured application of checklists significantly enhances patient safety in elderly individuals. It is recommended that all surgical team members, especially operating room nurses, consistently perform verification and monitoring of instruments to reduce the risk of complications and improve the quality of surgical care.References
Badiee, B., Mallick, S., Ali, K., Justo, M., Mahrokhi, S., & Benharash, P. (2025). Retained foreign bodies after major operations: Trends, risk factors, and associated outcomes. Surgery, 185, 109513. https://doi.org/10.1016/j.surg.2025.109513
Berra, L. V., Cedrone, G., Di Norcia, V., D’Angelo, L., Brunetto, F., Familiari, P., Palmieri, M., Capobianco, M., Pappone, F., & Santoro, A. (2023). Development of a novel device for decompressive craniectomy: An experimental and cadaveric study and preliminary clinical application. Operative Neurosurgery, 24(3), 324–330. https://doi.org/10.1227/ons.0000000000000530
Ferreira, A., Cerejo, A., Silva, P. A., & Viegas, V. (2024). Predictive factors for cranioplasty complications—A decade’s experience. Brain and Spine, 4, 102925. https://doi.org/10.1016/j.bas.2024.102925
Garcia, J. R., Allende, F., Kogan, M., & Chahla, J. (2024). When things go wrong: A guide to the medical, ethical, and legal dimensions of surgical complications. JAAOS Global Research & Reviews, 8(12), e24.00004. https://doi.org/10.5435/JAAOSGlobal-D-24-00004
García-Pérez, D., Castaño-León, A. M., Moreno-Gómez, L. M., Esteban-Sinovas, O., García-Posadas, G., Panero-Pérez, I., Paredes, I., Gómez-López, P. A., & Lagares, A. (2023). Novel CT-based parameters assessing relative cross-sectional area to guide surgical management and predict clinical outcomes in patients with acute subdural hematoma. Neuroradiology, 65(3), 489–501. https://doi.org/10.1007/s00234-022-03087-5
Gomes, E. T., Galvão, M. C. B., Shimoda, G. T., de Araújo Püschel, V. A., & de Oliveira, L. B. (2021). Surgical counts in open abdominal and pelvic surgeries in a university hospital: A best practice implementation project. JBI Evidence Implementation, 19(1), 84–93. https://doi.org/10.1097/XEB.0000000000000253
Guo, L., Zuo, H., Sun, Y., & Qian, C. (2025). Elevating surgical outcomes: A comprehensive analysis of innovative nursing practices in intraoperative care across diverse specialties. Frontiers in Medicine, 12, 1665160. https://doi.org/10.3389/fmed.2025.1665160
Hanko, M., Snopko, P., Opšenák, R., Kolarovszki, B., Soršák, J., & Zeleňák, K. (2021). Incidence and risk factors of early postoperative complications in patients after decompressive craniectomy: A 5-year experience. European Journal of Trauma and Emergency Surgery, 47(5), 1635–1647. https://doi.org/10.1007/s00068-020-01367-4
Harlanu, M., Suryanto, A., Ramadhan, S., & Wuryandini, E. (2023). Construct validity of the instrument of digital skill literacy. Cakrawala Pendidikan, 42(3), 781–790. https://doi.org/10.21831/cp.v42i3.59703
Hatamleh, M. M. (2022). Contemporary review on craniectomy and cranioplasty; Part 1: Decompressive craniectomy. Journal of Craniofacial Surgery, 33(3), 838–841. https://doi.org/10.1097/SCS.0000000000008041
Jia, Z., Li, J., Shan, Y., Xu, D., & Li, J. (2025). Clinical analysis of causes and preventive measures of complications after decompressive craniectomy for craniocerebral trauma. Pakistan Journal of Medical Sciences, 41(5), 1376–1380. https://doi.org/10.12669/pjms.41.5.10382
Kapapa, T., Jesuthasan, S., Schiller, F., Schiller, F., Woischneck, D., Gräve, S., Barth, E., Mayer, B., Oehmichen, M., & Pala, A. (2024). Outcome after decompressive craniectomy in older adults after traumatic brain injury. Frontiers in Medicine, 11, Article 1422040. https://doi.org/10.3389/fmed.2024.1422040
Kim, J. H., Choo, Y. H., Jeong, H., Kim, M., Ha, E. J., Oh, J., & Lee, S. (2023). Recent updates on controversies in decompressive craniectomy and cranioplasty: Physiological effect, indication, complication, and management. Korean Journal of Neurotrauma, 19(2), 128–148. https://doi.org/10.13004/kjnt.2023.19.e24
Maas, A. I. R., Menon, D. K., Manley, G. T., Abrams, M., Åkerlund, C., Andelic, N., Aries, M., Bashford, T., Bell, M. J., Bodien, Y. G., Brett, B. L., Büki, A., Chesnut, R. M., Citerio, G., Clark, D., Clasby, B., Cooper, D. J., Czeiter, E., Czosnyka, M., ... Zemek, R. (2022). Traumatic brain injury: Progress and challenges in prevention, clinical care, and research. The Lancet Neurology, 21(11), 1004–1060. https://doi.org/10.1016/S1474-4422(22)00309-X
Mee, H., Kolias, A. G., Hutchinson, P. J., Harris, J. M., Korhonen, T., Anwar, F., Whiting, G., Viaroli, E., Timofeev, I., Helmy, A., Wahba, A. J., & Martin, M. (2024). Decompressive craniectomy to cranioplasty: A retrospective observational study using Hospital Episode Statistics in England. BMJ Surgery, Interventions, & Health Technologies, 6(1). https://doi.org/10.1136/bmjsit-2023-000253
Nichol, P. F., & Saari, M. J. (2023). Risk modeling of errors in the surgical instrument cycle: Insights into solutions for an expensive and persistent problem. Perioperative Care and Operating Room Management, 32, 100333. https://doi.org/10.1016/j.pcorm.2023.100333
Niedermeyer, S., Leiber, M., Terpolilli, N. A., Weig, T., & Stöcklein, S. (2025). Impact of frailty in elderly patients undergoing decompressive craniectomy after traumatic brain injury. Neurosurgical Review, 48(1). https://doi.org/10.1007/s10143-025-03442-z
Reddy, C., Bains, L., Kumar, P. K., & Zadey, S. (2025). Transforming surgical care and safety: Dissecting the impact of checklists in the Global South. Frontiers in Surgery, 12, 1664277. https://doi.org/10.3389/fsurg.2025.1664277
Schröder, I., Güresir, E., Vatter, H., & Soehle, M. (2024). Single-centre real-life observational study on mortality and outcomes: Decompressive craniectomy and brain death in traumatic brain injury, haemorrhage, and other cerebral diseases. Acta Neurochirurgica, 166(1). https://doi.org/10.1007/s00701-024-06170-3
Tyagi, M., Mahajan, C., & Kapoor, I. (2021). Role of decompressive craniectomy. In Essentials of evidence-based practice of neuroanesthesia and neurocritical care. Elsevier. https://doi.org/10.1016/B978-0-12-821776-4.00019-6
Veldeman, M., Daleiden, L., Hamou, H., Höllig, A., & Clusmann, H. (2021). An altered posterior question-mark incision is associated with a reduced infection rate of cranioplasty after decompressive hemicraniectomy. Journal of Neurosurgery, 134(4), 1262–1270. https://doi.org/10.3171/2020.2.JNS193335
Vitali, M., Marasco, S., Romenskaya, T., Elia, A., Longhitano, Y., Zanza, C., Abenavoli, L., Scarpellini, E., Bertuccio, A., & Barbanera, A. (2023). Decompressive craniectomy in severe traumatic brain injury: The intensivist’s point of view. Diseases, 11(1), 22. https://doi.org/10.3390/diseases11010022
Yan, Z., Li, X., Xia, B., Xue, C., Wang, Y., Che, H., Shen, D., & Guo, S. (2024). Predictive factors influencing outcome of early cranioplasty after decompressive craniectomy: An outcome prediction model study. Frontiers in Neurology, 15, Article 1384320. https://doi.org/10.3389/fneur.2024.1384320
Zietlow, K. E., Wong, S., Heflin, M. T., McDonald, S. R., Sickeler, R., Devinney, M., Blitz, J., Lagoo-Deenadayalan, S., & Berger, M. (2022). Geriatric preoperative optimization: A review. The American Journal of Medicine, 135(1), 39–48. https://doi.org/10.1016/j.amjmed.2021.07.028












