Cancellation Of Elective Cases Research Articles

Surgical education in the post-COVID era: an EAES DELPHI-study

BackgroundsTo date, it is unclear what the educational response to the restrictions on minimally invasive surgery imposed by the COVID-19 pandemic have been, and how MIS-surgeons see the post-pandemic future of surgical education. Using a modified Delphi-methodology, this study aims to assess the effects of COVID on MIS-training and to develop a consensus on the educational response to the pandemic.MethodsA three-part Delphi study was performed among the membership of the European Association of Endoscopic Surgery (EAES). The first survey aimed to survey participants on the educational response in four educational components: training in the operating room (OR), wet lab and dry lab training, assessment and accreditation, and use of digital resources. The second and third survey aimed to formulate and achieve consensus on statements on, and resources in, response to the pandemic and in post-pandemic MIS surgery.ResultsOver 247 EAES members participated in the three rounds of this Delphi survey. MIS-training decreased by 35.6–55.6%, alternatives were introduced in 14.7–32.2% of respondents, and these alternatives compensated for 32.2–43.2% of missed training. OR-training and assessments were most often affected due to the cancellation of elective cases (80.7%, and 73.8% affected, respectively). Consensus was achieved on 13 statements. Although digital resources were deemed valuable alternatives for OR-training and skills assessments, face-to-face resources were preferred. Videos and hands-on training–wet labs, dry labs, and virtual reality (VR) simulation–were the best appreciated resources.ConclusionsCOVID-19 has severely affected surgical training opportunities for minimally invasive surgery. Face-to-face training remains the preferred training method, although digital and remote training resources are believed to be valuable additions to the training palette. Organizations such as the EAES are encouraged to support surgical educators in implementing these resources. Insights from this Delphi can guide (inter)national governing training bodies and hospitals in shaping surgical resident curricula in post pandemic times.

Cancellation of Elective Cases in Songklanagarind Hospital: Identification of Reason: A Retrospective Study

Background: The operating theatre is the most important department of a hospital as it involves significant resources. One of the significant obstacles in overseeing a theater managing system is scheduled elective case cancellation. Objective: The present study was conducted to identify preventable reasons for cancellation. Materials and Methods: A retrospective study was conducted between January and December 2018. Data from scheduled elective cases were retrieved from a database of the Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University. All patients who required anesthetization for surgery were divided into two groups, proceeding with the operation, and case cancellation. Baseline characteristics of the two groups were compared using the chi-square test, Fisher’s exact test, and analysis of variance. All statistical analyses were performed using the R software, and the correlation was considered significant at p of less than 0.05. The reason for case cancellations was categorized into three groups, preventable, unpreventable, inconclusive, then displayed as percentages. Results: In all, 12,423 patients were identified as being scheduled elective cases. The case cancellation rate was 6.4%. Cancellation rates of males and females were 7.3% and 5.6%, respectively. Patients aged 65 to 79 years exhibited a 7.6% cancellation rate, and the cancellation rate was the highest at 17.3% in the American Society of Anesthesiologists (ASA) physical status classification 4. Of the 797 canceled surgeries, 397 cases (50%) were preventable, 192 cases (24%) were unpreventable, and 208 cases (26%) involved inconclusive reasons. The preventable reasons for cancellation comprised incomplete medical evaluations in 179 cases (22.5%), overtime in 74 cases (9.3%), and the patient refused surgery in 52 cases (6.5%). Conclusion: The most common cause of elective case cancellation is an incomplete preoperative evaluation, which is a preventable reason.Therefore, preoperative evaluation protocol as a one-stop service preoperative clinic should be established to prevent and decrease the cancellation rate of elective cases. Keywords: Cancellation case; Elective surgery; Preventable reason

The impact of acute surgical unit rostering on National Emergency Access Targets during the COVID-19 pandemic: a single hospital experience.

BackgroundSurgical departments have been dramatically impacted by the novel coronavirus 19 (COVID‐19) pandemic, with the cancellation of elective cases and changes to the provision of emergency surgical care. The aim of this study was to determine whether structural changes made within our facility's surgical department during COVID‐19 altered National Emergency Access Target (NEAT) times and impacted on patient outcomes.MethodsEmergency surgical cases over a 4‐month time period were retrospectively collected and statistically analysed, divided into pre‐ and mid‐COVID‐19 pandemic.ResultsBaseline characteristics between the groups were comparable. There was a significant increase in consultant presence in theatre in the COVID group. There were also statistically significant reductions in NEAT times at each timepoint, although these did not meet national guidelines. There was no change in emergency surgical workload, complication rate or mortality rates within 30 days.ConclusionAny significant change to services requires a coordinated hospital‐wide approach, not just from a single department, and clinicians must continue to be wary of benchmarked times as the overall feasibility and safety of NEAT times has also been highlighted again.

Challenges in the Cardiothoracic and Vascular Anesthesia Fellowship Program Since the Coronavirus Disease 2019 (COVID-19) Pandemic: An Electronic Survey on Potential Solutions

ObjectiveThe authors explored the current practice of fellowship training in cardiothoracic and vascular anesthesia and surveyed the acceptability of potential solutions to mitigate the interrupted fellowship training during the severe acute respiratory syndrome coronavirus disease 2019 (COVID-19) pandemic. DesignA prospective electronic questionnaire-based survey. SettingThe survey was initiated by the Education Committee of the European Association of Cardiothoracic Anesthesiology and Intensive Care (EACTAIC). ParticipantsThe study comprised EACTAIC fellows, EACTAIC, and non-EACTAIC subscribers to the EACTAIC newsletter and EACTAIC followers on different social media platforms. InterventionsAfter obtaining the consent of participants, the authors assessed the perioperative management of COVID-19 patients, infrastructural aspects of the workplace, local routines for preoperative testing, the perceived availability of personal protective equipment (PPE), and the impact of COVID-19 on fellowship training. In addition, participants rated suggested solutions by the investigators to cope with the interruption of fellowship training, using a traffic light signal scale. Measurements and Main ResultsThe authors collected 193 responses from 54 countries. Of the respondents, 82.4% reported cancelling or postponing elective cases during the first wave, 89.7% had provided care for COVID-19 patients, 75.1% reported staff in their center being reassigned to work in the intensive care unit (ICU), and 45% perceived a shortage of PPE at their centers. Most respondents reported the termination of local educational activities (79.6%) and fellowship assessments (51.5%) because of the pandemic (although 84% of them reported having time to participate in online teaching), and 83% reported a definitive psychological impact. More than 90% of the respondents chose green and/or yellow traffic lights to rate the importance of the suggested solutions to cope with the interrupted fellowship training during the pandemic. ConclusionsThe COVID-19 pandemic led to the cancellation of elective cases, the deployment of anesthesiologists to ICUs, the involvement of anesthesiologists in perioperative care for COVID-19 patients, and the interruption of educational activities and trainees’ assessments. There is some consensus on the suggested solutions for mitigation of the interruption in fellowship training.

Early Changes to Neurosurgery Resident Training During the COVID-19 Pandemic at a Large U.S. Academic Medical Center

BackgroundThe coronavirus disease 2019 pandemic has led to sweeping changes in residency programs across the world, including cancellation of elective cases. The effects of safety measures on neurosurgical training remain unclear. To understand how neurosurgical residents have been affected, we analyzed the operative experience in the months leading up to and during the pandemic.MethodsThe resident and institutional case totals were tallied for a single residency program in Miami-Dade County from January 1, 2019 to June 30, 2020. A matched cohort analysis was performed before and during the pandemic to assess the effects on resident surgical training.ResultsThe case totals for all levels of training were lower when restrictions were placed on elective surgeries. An average of 11 cases was logged in April 2020, a decrease from 26 cases in April 2019 (95% confidence interval, 8.7–22; P < 0.01). An average of 20 cases was logged in May 2020, a decrease from 25 cases in May 2019 (95% confidence interval, 1.2–8.8; P = 0.01). In April and May 2020, 299 (66%) and 148 (50%) fewer cases had been performed at our institution compared with April and May 2109.ConclusionsOperative experience was reduced for residents during the months when the performance of elective cases was restricted. Our data suggest experience in some areas of neurosurgery were more affected than were others, and residents at different levels of training were also affected differently. However, the extent of the coronavirus disease 2019 pandemic on neurosurgical training is unlikely to be understood in the short term.

Letter: COVID-19 Pandemic-The Bystander Effect on Stroke Care in Michigan.

Letter: COVID-19 Pandemic-The Bystander Effect on Stroke Care in Michigan.

Sheltered Neurosurgery During COVID-19: The Emory Experience

BackgroundThe 2019 novel coronavirus disease (COVID-19) pandemic has directly and indirectly impacted health care systems, including residency programs. Social distancing, cancellation of elective cases, and staff re-deployment have compromised clinical and academic teaching. We describe the neurosurgical experience at Emory University during the COVID-19 pandemic and the impact of COVID-19-related policies on resident experience.MethodsWe retrospectively reviewed all neurosurgical cases performed at Emory University Hospital between March 16, the day cancellation of elective cases was effective, and April 15, 2020, and the same period in the preceding 3 years. For the study period, we collected the number of cases and their distribution by subspecialty along with total hospital charges.ResultsCompared with an average of 606 cases performed during the study period over the past 3 years, only 145 neurosurgical cases were performed between March 16 and April 15, 2020, which corresponds to an 80% reduction in case volume and 66% decrease in hospital revenue in 2020. When divided by subspecialty, the most significant reduction was observed in functional (84%; P < 0.01) followed by spine (78%; P < 0.01) surgery, although all subspecialties were significantly impacted. Assessing junior resident experience, we observed a significant reduction in number of neurosurgical admissions (47%; P < 0.01) and bedside procedures (59%; P < 0.01) in the study period in 2020 compared with the past 3 years, with no significant reduction in number of consultations (17%; P > 0.1).ConclusionsEven at academic centers that were not hugely impacted by the COVID-19 pandemic, prophylactic and preparedness measures still exhibited an unprecedented toll on neurosurgical resident and fellow experience.

An overview of the situation of hand surgery in Spain during the peak of COVID-19 pandemic

Since the first cases were detected in China in December 2019, the COVID-19 pandemic has spread rapidly, collapsing many healthcare systems, and forcing them to adapt. Hand surgery has been indirectly affected by this scenario. This article aims to provide an overview on how Spanish hand surgeons have modified their daily practice. Based on a survey conducted nationwide, we observed a decrease in the number of emergency cases and cancellation of elective cases, shift to a more conservative treatment approach, use of personal protective equipment, and decrease in the number of outpatient visits and tests. Without definitive evidence at this point, knowing how we have dealt with the situation so far will help us adopt the needed measures to ensure both the patient's and surgeon's safety and manage available resources in future pandemics.

Well-being and education of urology residents during the COVID-19 pandemic: Results of an American National Survey.

BackgroundThe rapid spread of COVID‐19 has placed tremendous strain on the American healthcare system. Few prior studies have evaluated the well‐being of or changes to training for American resident physicians during the COVID‐19 pandemic. We aim to study predictors of trainee well‐being and changes to clinical practice using an anonymous survey of American urology residents.MethodsAn anonymous, voluntary, 47‐question survey was sent to all ACGME‐accredited urology programmes in the United States. We executed a cross‐sectional analysis evaluating risk factors of perception of anxiety and depression both at work and home and educational outcomes. Multiple linear regressions models were used to estimate beta coefficients and 95% confidence intervals.ResultsAmong ~1800 urology residents in the USA, 356 (20%) responded. Among these respondents, 24 had missing data leaving a sample size of 332. Important risk factors of mental health outcomes included perception of access to PPE, local COVID‐19 severity and perception of susceptible household members. Risk factors for declination of redeployment included current redeployment, having children and concerns regarding ability to reach case minimums. Risk factors for concern of achieving operative autonomy included cancellation of elective cases and higher level of training.ConclusionsSeveral potential actions, which could be taken by urology residency programme directors and hospital administration, may optimise urology resident well‐being, morale, and education. These include advocating for adequate access to PPE, providing support at both the residency programme and institutional levels, instituting telehealth education programmes, and fostering a sense of shared responsibility of COVID‐19 patients.

Maintaining Trauma Care Access During the COVID-19 Pandemic: An Urban, Level-1 Trauma Center's Experience.

Maintaining Trauma Care Access During the COVID-19 Pandemic: An Urban, Level-1 Trauma Center's Experience.

Reasons of cancellation of elective cases on the day of surgery - A retrospective study

Reasons of cancellation of elective cases on the day of surgery - A retrospective study

Cancellation of Elective Cases on the Day of Intended Surgery in a Tertiary Care Paediatric Hospital: Is it a Concern?

Cancellation of Elective Cases on the Day of Intended Surgery in a Tertiary Care Paediatric Hospital: Is it a Concern?

Cancellation of Elective Cases in a Recently Opened, Tertiary/Quaternary-Level Hospital in the Middle East.

Case cancellations have a negative financial impact due to revenue loss and the potential costs of underutilized time. The goals of this study at a recently opened hospital in the Middle East were to measure the cancellation rates for elective surgical or endoscopic cases and to identify the reasons for cancellation. During the 1-month study period, 170 (22.4%) of the 760 scheduled cases were cancelled. Cultural norms and patient no-shows on the day of surgery accounted for the majority of case cancellations. Understanding local factors on hospital functions may be vital for organizations expanding into new geographic areas.

Reasons for delay in turnover time in operating room- an observational study

Background: Operating room (OR) like casualty room is the most productive area of a hospital. Turnover time although is a non-productive time in the operating room, yet it is important. Its efficient utilisation require multidisciplinary team work especially supporting services which play a major role in reducing turnover time in the operating room. Since present medical college where study was being conducted is still in its evolving stage, it was considered desirable for its quality improvement to study various factors which are contributing in turnover time delay so that appropriate measures can be taken to prevent the undue turnover time delay.Materials and methods: Present prospective observational case study aims at measurement of turnover time delays during 100 working days which were completed over four months for two operation theatres. The variable chosen was the delay of turnover time from the benchmark time taken. The data were collected, compiled and analysed.Results: In orthopaedics OR 77% of turnovers were found within benchmark limits. Only in 23% cases turnovers were delayed. 47% of times hospital related issues were responsible. In surgery OR 79% of turnovers were within benchmark limits. 21% cases were delayed; of this hospital related problems caused delayed turnovers in 53% cases.Conclusions: The study concluded that reasons for delays centred on multifactorial reasons which were unavoidable and unpredictable. But if those problems that can be easily fixed are attended to, valuable time can be saved, which will ultimately keep the surgeries on schedule and will prevent cancellation of elective cases. The utilization of OT complex can be optimized by team effort, multitasking and parallel processing.Bangladesh Journal of Medical Science Vol.16(2) 2017 p.245-251

Cancellations of elective surgical procedures performed at a Teaching Hospital in North-West Nigeria

Background: Cancellation of cases on the scheduled day of surgery leads to inefficient utilization of operating theater space, waste of valuable workforce, and scarce resources for patients and hospitals. Objectives: The objective of this study is to determine the prevalence and reasons for cancellations of elective surgical procedures done at Aminu Kano Teaching Hospital, Kano. Materials and Methods: A retrospective cross-sectional descriptive study was undertaken by reviewing the list of all patients whose names appeared on the routine elective surgical operation lists in the Surgical Departments of the hospital, from January to September 2012. The list of those whose surgeries were cancelled was compiled. A sample of 200 cases (determined using appropriate formula, n = z 2 pq/d 2 ) were selected by stratified sampling technique with proportionate allocation. The demographic data, diagnosis, specialty of surgery, proposed surgery, and reasons for cancellation were extracted and analyzed. Results: A total of 2355 cases were booked for elective surgeries during the study. Out the 200 sample selected for the study, 97 were cancelled for various reasons giving a cancellation rate of 48.5%. Overall, Obstetrics and Gynecology accounted for the highest number of cases booked 27.5% (55 out of 200) and cancelled 27.8% (27 out of 97); and had the highest cancellation rate of 49.1% (27 out of 55). The most common reason for the cancellation was a patient factor (60.8%) arising from patient absconding from surgery for personal reasons not communicated to the surgeons, and lack of funds to pay for surgery. Conclusion: The prevalence of cancellation of elective cases on the scheduled day of surgery is still high in our hospital. Most of the causes of the cancellations are due to patient-related factors which are preventable and avoidable. Avoidance of unnecessary cancellations of cases is an important way of ensuring efficient utilization of scarce resources. Adequate counseling before, during, and after elective surgical procedures in our setting is highly recommended.

Dedicated operating room for emergency surgery improves access and efficiency

Scheduling emergency cases among elective surgeries often results in prolonged waits for emergency surgery and delays or cancellation of elective cases. We evaluated the benefits of a dedicated operating room (OR) for emergency procedures available to all surgical services at a large children's hospital. We compared a 6-month period (January 2009 to June 2009) preimplementation with a 6-month period (January 2010 to June 2010) postimplementation of a dedicated OR. We evaluated OR use, wait times, percentage of cases done within and outside of access targets, off-hours surgery, cancellations, overruns and length of stay. Preimplementation, 1069 of the 5500 surgeries performed were emergency cases. Postimplementation, 1084 of the 5358 surgeries performed were emergency cases. Overall use of the dedicated OR was 53% (standard deviation 25%) postimplementation. Excluding outliers, the average wait time for priority 3 emergency patients decreased from 11 hours 8 minutes to 10 hours 5 minutes (p = 0.004). An increased proportion of priority 3 patients, from 52% to 58%, received surgery within 12 hours (p = 0.020). There was a 9% decrease in the proportion of priority 3 cases completed during the evening and night (p < 0.001). The elective surgical schedule benefited from the dedicated OR, with a significant decrease in cancellations (1.5% v. 0.7%, p < 0.001) and an accumulated decrease of 5211 minutes in overrun minutes in elective rooms. The average hospital stay after emergency surgery decreased from 16.0 days to 14.7 days (p = 0.12) following implementation of the dedicated OR. A dedicated OR for emergency cases improved quality of care by decreasing cancellations and overruns in elective rooms and increasing the proportion of priority 3 patients who accessed care within the targeted time.

Reasons For Cancellation of Elective Paediatric Surgery Cases

Many factors have contributed to incessant cancellation of elective cases in paediatric surgery. The objective of this study was to review the reasons for cancellation of such cases in our centre and to suggest solutions to these problems. Prospective collation of information on all cancelled elective paediatric surgical cases was done. The bio-data on; clinical diagnosis and reasons for cancellation were documented. The study period was 18 months (March 2006- August 2007). Causes of cancellation were grouped into patients' factors (group A), parental factors (group B), and institutional factors (group C) There were 437 elective paediatric surgery cases within this period of which 298 (68.2%) were day cases and 139 (31.8%) were in-patients. Sixty-one patients (14%) were cancelled [36 (8.2%) day cases and 25 (5.8%) in-patients] of which 49 (80.3%) were males, 10 (16.4%) were females and 2 (3.3%) cases of ambiguous genitalia. The age ranged between 30 days and 11 years with a mean of 33.4 months ± SD of 34.4 months. The commonest reason for cancellation were in group A (22, 36.1%), followed by groups B and C (17or 27.9% each). The commonest reason in group A was Upper respiratory tract infection (59.1%), for group B was parents' refusal to present wards on the day of surgery (88.2%) and for group C was impromptu public holidays (58.8%). Elective paediatric surgery cases are usually cancelled in our centre due to Upper Respiratory Tract Infection (URTI) in children and parents' refusal to present their wards on surgery day. There is a need to properly review children with runny nostrils before cancellation because some children's nostrils are chronically wet and it may be delicate to postpone their operation. Adequate counseling of parents will reduce default.Keywords: cancellation, elective, day-case, paediatric surgery

Cancellation of elective cases in pediatric surgery: An audit

Aim:To determine the main reasons for cancellation of elective cases on scheduled date of surgery in pediatric patients.Materials and Methods:The audit was conducted in a 216 beds tertiary care pediatric super-specialty hospital. Two operation theatres (OT) provide elective surgical services to pediatric surgery, orthopedics, ophthalmology and otorhinolaryngology. The audit included all those patients who were posted for elective surgery over a period of one year. Cancelled cases were identified from predesigned OT utilization formats and the reasons for cancellation were evaluated.Results:A total of 2473 cases were posted for the elective surgery in the year 2009 and 189 (7.64%) patients had their surgery cancelled. The main reasons for cancellation were upper respiratory infections (30.68%) and shortage of time (29%). Other reasons were medically unfit patients (15.34%), precedence of emergency cases (3.7%); non-availability of ventilator and intensive care bed (4.7%); no-show by patient (4.76%); non-availability of blood (4.2%); incomplete work up (2.64%); administrative reasons (1.58%); patient not fasting (1.58%) and unspecified reasons (2.1%). Overall, 38.6% causes were preventable.Conclusions:Elective surgery cancellation is a significant problem with multifactorial etiology. Most common reasons for cancellation of planned surgery were sudden onset of respiratory tract infection in the admitted patient and shortage of time. It suggests that on many occasions, surgeons take more time than anticipated for performing the procedure.