Cancellation Of Surgery Research Articles

Spinal versus general anesthesia: Comparing outcomes in pediatric patients undergoing urologic procedures

Available literature comparing spinal anesthesia (SA) to general anesthesia (GA) in the pediatric population describes multiple benefits in appropriately selected patients including cost reduction, lower incidence of complications, and shorter operative times. In patients undergoing urologic procedures, data are sparse. Our goal was to expand on the paucity of existing urologic literature as SA appears to be uniquely suited for a substantial number of its common pediatric procedures. Within a single institution, patients who had a urologic procedure performed under SA between May 2019 and July 2021 and were less than 18 months old were compared with a matched cohort of patients who had GA. The SA and GA groups were compared by two-sample t-tests, chi-square test for independence, and Fisher's exact test. There were a total of 184 SA and 202GA patients. There was no significant difference in the demographics except that SA patients were younger and weighed less than GA patients. The patients in the SA group needed less opioids both during the surgery (0% vs 26.1% p N/A) and in the immediate postoperative period when compared with GA patients (0% vs 18.2% p N/A). The patients who had SA had fewer complications necessitating PICU admission, or cancellation of surgery (0% vs 6.8% p=0.03). Total anesthesia and emergence time were lower for SA patients (41 vs 50.2 p=0.001 & 3.4 vs 6.1 p=0.001). Both surgery and total OR time were not different between the groups (37.6 vs 35.5 p=0.35 and 56.3 vs 54.4 p=0.49). Overall, raw material cost was also found to be lower per procedure in the SA group vs the GA group ($8.90 vs $38.8: 77% reduction). Adjusted total mean costs for the surgery were not different between groups. The reduction in opioid use postoperatively also suggests reduced cost in the management of postoperative pain in the SA group. Total anesthesia time, opioid use, and serious complications were all significantly lower in the SA group. We did not find significant difference in total surgery cost between two groups. However, patients who had SA had better pain control and needed less rescue analgesics in the immediate postoperative period. No patients in either group were sent home with opioids. Spinal anesthesia was found to be an equally effective and appropriate alternative to GA with many proposed benefits for common pediatric urologic procedures. With further research, SA may prove to be a safer alternative in patients at risk for complications related to GA general anesthesia while also offering a cost benefit.

Impact of Comorbidities on Cancellation of Surgery in Patients Previously Reviewed: A Prospective Observational Study

Impact of Comorbidities on Cancellation of Surgery in Patients Previously Reviewed: A Prospective Observational Study

The financial impact of the COVID-19 pandemic on sleeve gastrectomy at a major academic institution.

The COVID-19- pandemic significantly impacted metabolic and bariatric surgery (MBS) practices due to large-scale surgery cancellations along with staff and supply shortages. We analyzed sleeve gastrectomy (SG) hospital-level financial metrics before and after the COVID-19 pandemic. Hospital cost-accounting software (MicroStrategy, Tysons, VA) was reviewed for revenues, costs, and profits per SG at an academic hospital (2017-2022). Actual figures were obtained, not insurance charge estimates or hospital projections. Fixed costs were obtained through surgery-specific allocation of inpatient hospital and operating-room costs. Direct variable costs were analyzed with sub-components including: (1) labor and benefits, (2) implants, (3) drug costs, and 4) medical/surgical supplies. The pre-COVID-19 period (10/2017-2/2020) and post-COVID-19 period (5/2020-9/2022) financial metrics were compared with student's t-test. Data from 3/2020 to 4/2020 were excluded due to COVID-19-related changes. A total of 739 SG patients were included. Average length of stay (LOS), Center for Medicaid and Medicare Case Mix Index (CMI), and percentage of patients with commercial insurance were similar pre vs. post-COVID-19 (p > 0.05). There were more SG performed per quarter pre-COVID-19 than post-COVID-19 (36 vs. 22; p = 0.0056). Pre-COVID-19 and post-COVID-19 financial metrics per SG differed significantly for, respectively, revenues ($19,134 vs. $20,983) total variable cost ($9457 vs. $11,235), total fixed cost ($2036 vs. $4018), total profit ($7571 vs. $5442), and labor and benefits cost ($2535 vs. $3734; p < 0.05). The post-COVID-19 period was characterized by significantly increased SG fixed cost (i.e., building maintenance, equipment, overhead) and labor costs (increased contract labor), resulting in precipitous profit decline that crosses the break-even in calendar year quarter (CQ) 3, 2022. Potential solutions include minimizing contract labor cost and decreasing LOS.

Elective day of surgery cancellations: A retrospective observational study

Background Day-of-surgery (DOS) cancellations are a common and frustrating phenomenon for surgical patients globally. They are both costly to health systems and patients, causing inconvenience, decreased productivity, and emotional distress. In Australia, there are only few published literature that have explored DOS cancellations. Aim This study aimed to evaluate the frequency and reasons for DOS cancellations in a South-East Queensland tertiary hospital. Secondly, the study aimed to understand the characteristics of patients who have been cancelled on day of surgery. Methods A retrospective observational design was used to investigate elective day of surgery cancellations over one year, from January to December 2019. Variables collected included patients’ age, gender, ethnicity, socio-demographic status, carer responsibilities, attendance at pre-admission clinic (PAC), American Society of Anaesthesiologists status; surgical specialty; category of surgery; date of placement on elective surgery waitlist; ethnicity; suburb of residence; socio-demographic status derived from postcode, employment status, carer responsibilities for other(s); number of times of failure to attend past appointments; presentation at PAC; referrals to other services such as the pre-anaesthetic assessment nurse, nurse navigator or social worker and indigenous liaison health officer during the surgery planning phase, and reasons for cancellation. Mean and standard deviation were calculated to describe age. Frequencies and percentages were also reported. Findings Over 1 year, 5334 elective surgeries occurred: of these, 412 patients (8%) were affected by DOS cancellations. Hospital-initiated cancellations accounted for 32% (113/412) of total cancellations, including reasons such as patients’ condition, treatment no longer required or surgeons opting not to perform the procedure. The mean age of patients affected by cancellation was 58 years (SD 17.5). Male patients accounted for a greater proportion of cancellations than females (251 versus 161; 61% versus 39%). Almost half of cancellations were patients who were booked as inpatient admissions (47%, 193/412). Cardiothoracic comprised the specialty most affected by DOS cancellations (43%, 177/412 of cancelled patients). Conclusion By identifying the reasons for cancellation, and the characteristics of patients who are prone to being cancelled on the day of surgery, we have highlighted that DOS cancellations may be preventable in some cases. Further, quality improvement projects or root cause analysis are required to investigate and further address preventable DOS cancellation.

Prevalence and characteristics of paediatric X-linked hypophosphataemia in Australia and New Zealand: Results from the Australian and the New Zealand Paediatric Surveillance Units survey

BackgroundX-linked hypophosphataemia (XLH) is the most common heritable form of rickets. Prevalence data varies across the literature between 1 in 20,000 and 1 in 200,000 per population. MethodsAustralian and New Zealand Paediatric Surveillance Units collected cross-sectional data from paediatricians on existing cases to estimate prevalence and characteristics of paediatric XLH in Australia and New Zealand. ResultsSeventy-five cases in Australia and 18 cases in New Zealand were identified. Estimated minimum prevalence based on these cases was 1.33 (1.04–1.66) per 100,000 and 1.60 per 100,000 (95%CI 0.97–2.58) in Australia and New Zealand respectively, with actual prevalence likely higher due to incomplete ascertainment. Despite a family history in most cases, delayed diagnosis was common, with 49 % diagnosed after 2 years of age. Delayed diagnosis was more common in sporadic versus familial cases. Most common clinical characteristics included leg bowing (89 %), bone and joint pain (68 %), abnormal gait (57 %) and short stature (49 %). There was a significant burden of orthopaedic disease and surgeries and a high rate of complications of nephrocalcinosis and hyperparathyroidism (32 % and 20 % respectively). Additionally, while guidelines stress the importance of multidisciplinary care, many did not have access to recommended health professionals, with only 3 % seeing a psychologist and 68 % seeing a dentist. This is despite the high psychological burden of XLH and a significant proportion (41 %) of this cohort having dental issues (tooth abscess, dental capping, tooth extraction).There were two cases from NZ without data available. Of the 91 cases with data collected, 46 % were on burosumab therapy. Consistent with clinical trials, those on burosumab had a higher serum phosphate levels (p < 0.001) at most recent follow-up. Three cases reported cancellation of orthopaedic surgery due to improvement in lower limb deformity after commencement of burosumab. ConclusionThese data describe the multisystem burden of disease for children with XLH with care impacted by delayed diagnosis and a lack of access to many health professionals, especially psychological support.

The Association of Bedside Nurse Staffing on Patient Outcomes and Throughput in a Pediatric Cardiac Intensive Care Unit

AbstractHealth care throughput is the progression of patients from admission to discharge, limited by bed occupancy and hospital capacity. This study examines heart center throughput, cascading effects of limited beds, transfer delays, and nursing staffing on outcomes utilizing elective surgery cancellation during the initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic wave. This study was a retrospective single-center study of staffing, adverse events, and transfers. The study period was January 1, 2018 to December 31, 2020 with the SARS-CoV-2 period March to May 2020. There were 2,589 patients, median age 5 months (6 days–4 years), 1,543 (60%) surgical and 1,046 (40%) medical. Mortality was 3.9% (n = 101), median stay 5 days (3–11 days), median 1:1 nurse staffing 40% (33–48%), median occupancy 54% (43–65%) for step-down unit, and 81% (74–85%) for cardiac intensive care unit. Every 10% increase in step-down unit occupancy had a 0.5-day increase in cardiac intensive care unit stay (p = 0.044), 2.1% increase in 2-day readmission (p = 0.023), and 2.6% mortality increase (p &lt; 0.001). Every 10% increase in cardiac intensive care unit occupancy had 3.4% increase in surgical delay (p = 0.016), 6.5% increase in transfer delay (p = 0.020), and a 15% increase in total reported adverse events (p &lt; 0.01). Elective surgery cancellation is associated with reduced high occupancy days (23–10%, p &lt; 0.001), increased 1:1 nursing (34–55%, p &lt; 0.001), decreased transfer delays (19–4%, p = 0.008), and decreased mortality (3.7–1.5%, p = 0.044). In conclusion, Elective surgery cancellation was associated with increased 1:1 nursing and decreased mortality. Increased cardiac step-down unit occupancy was associated with longer cardiac intensive care unit stay, increased transfer, and surgical delays.

(462) Penile Implant Cancellations During the COVID-19 Pandemic- A Retrospective Cohort Study

Abstract Introduction During the early stages of the COVID-19 pandemic, hospitals prioritized the availability of ventilators, anesthesia personnel, hospital beds, and personal protective equipment; consequently, widespread recommendations were made to postpone or cancel all elective procedures [1,2]. Determination of what was considered “elective” in urology was ill-defined, though there was consensus by international and European urologic societies that the “lowest priority” tier of procedures included those for functional and reconstructive urology, urogynecology, infertility, and prosthetic surgery [3,4]. Though these are indicated for benign conditions, the long-term impact of remaining under-treated is unknown. No data in the existing literature describe the effect of prosthetic surgery cancelations on patient outcomes during the COVID-19 pandemic. Objective To determine the primary reasons for cancelation of penile prosthetic implantation during the COVID-19 pandemic and to assess subsequent patient outcomes. Methods In this retrospective cohort study, all male patients ≥18 years old scheduled for implantation of a penile prosthesis at our institutions during a 2-year span (1/1/20 to 1/1/22) were eligible for inclusion. Data were abstracted from Epic with ICD-10 and CPT codes for erectile dysfunction and penile prostheses, respectively. Information collected about patients included age, ethnicity, marital status, SHIM score, prior penile implant status, prostate cancer history and therapy, initial date of surgery, cardiac/medical clearance status, cancelation status and cause, whether surgery was rescheduled, and if the surgery ultimately occurred. Crude and adjusted associations between factors related to cancellations were assessed using binary logistic regression and summarized as odds ratio (OR) along with 95% confidence intervals (CI). All statistical analyses were performed using SPSS 28.0.1. Results Of the 284 patients that met inclusion criteria, 77 (27.1%) had their surgeries canceled; of those, 33 (42.9%) were later rescheduled, with 31 (93.9%) ultimately undergoing the procedure. There was no significant difference in the average age or SHIM score of those who were and were not canceled. Only 9 (11.7%) of the cancelations were ordered by the hospital, with 4 (5.2%) canceled because of the restriction on elective procedures and 4 (5.2%) due to patients testing positive for COVID. 68 (88.3%) of the cancelations were at the behest of patients; 3 (3.9%) elected not to undergo surgery during the pandemic. The remaining 65 (84.4%) canceled for a variety of reasons, including not getting a pre-procedure UA or COVID test. Patients who did not receive cardiac/medical clearance were three times more likely to cancel (OR 3.04; 95% CI = 1.72-5.37; P&amp;lt;0.001). This association remained statistically significant after adjusting for insurance status (OR 2.32; 95% CI = 1.24-4.34; P=0.009). Conclusions Our data revealed that most cancelations of penile prosthetic implantations during COVID-19 were patient-instigated, with few cancelations due to COVID-19 infection or reluctance to have surgery during the pandemic. Most cancelations appeared secondary to difficulties with pre-procedure labs/testing, likely to have been an indirect consequence of the COVID-19 pandemic. Severely limited availability of PCP or lab appointments caused patients increased difficulty obtaining the necessary testing before surgery. Nevertheless, many of the canceled patients were able to reschedule, with nearly all ultimately undergoing the procedure. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Rigicon, Coloplast, Baxter.

Impact of pausing elective hip and knee replacement surgery during winter 2017 on subsequent service provision at a major NHS Trust: a descriptive observational study using interrupted time series

ObjectivesTo explore the impact of a temporary cancellation of elective surgery in winter 2017 on trends in primary hip and knee replacement at a major National Health Service (NHS) Trust,...

P156 Audit of day of surgery cancellations of elective caesarean sections

P156 Audit of day of surgery cancellations of elective caesarean sections

An audit to assess the number and reasons for on-the-day cancellations of elective oral and maxillofacial surgeries

The aim of this audit was to identify the magnitude of on-the-day elective surgery cancellations within the oral and maxillofacial department at East Kent Hospital University Foundation Trust, and then to be able to evaluate the reasons for them and suggest any necessary improvements to alleviate the situation.

Efficacy of Telehealth in Preoperative Pediatric Surgery Consultations

IntroductionThe Coronavirus disease 2019 pandemic created a sudden need to transition outpatient pediatric surgical care to a telehealth platform, allotting little time to study the efficacy of these changes. In particular, the accuracy of telehealth preoperative assessment remains unclear. Therefore, we sought to study the prevalence of errors in diagnosis and procedure cancellations between preoperative in-person evaluations and telehealth evaluations. MethodsWe conducted a single institution, retrospective chart review of perioperative medical records at a tertiary children's hospital over a 2-year period. Data included patient demographics (age, sex, county, primary language, and insurance), preoperative diagnosis, postoperative diagnosis, and surgical cancellation rates. Data were analyzed using Fisher's exact and chi-square tests. Alpha was set at 0.05. ResultsA total of 523 patients were analyzed, with 445 in-person visits and 78 telehealth visits. There were no demographic differences between the in-person and telehealth cohorts. The frequency of changes from the preoperative to the postoperative diagnosis was not significantly different between in-person preoperative visits and telehealth preoperative visits (0.99% versus 1.41%, P = 0.557). The frequency of case cancellations between the two consultation modalities was not significantly different (9.44% versus 8.97%, P = 0.899). ConclusionsOur results demonstrate that preoperative pediatric surgical consultations held via telehealth were neither associated with a decrease in the accuracy of preoperative diagnosis, nor an increased rate of surgery cancellations, compared to those held in-person. Further study is needed to better determine the advantages, disadvantages, and limitations of telehealth in the delivery of pediatric surgical care.

Cancellation of elective surgery and associated factors among patients scheduled for elective surgeries in public hospitals in Harari regional state, Eastern Ethiopia.

Canceling elective surgeries is a significant problem in many hospitals leading to patient dissatisfaction, increased costs, and emotional trauma for patients and their families. Despite this, there is limited information about the cancellation of elective surgeries in Ethiopia, mainly in the study area. This study aimed to assess the magnitude of cancellation and associated factors among patients scheduled for elective surgeries in public hospitals in the Harari Regional State, Eastern Ethiopia, from 1 August to 30 August 2021. A hospital-based cross-sectional study was conducted on 378 patients scheduled for elective surgeries. Data were gathered using a non-random sequential sampling approach. In addition, a structured face-to-face interviewer-administered questionnaire was employed. The gathered information was input into Epidata version 3.1 and then exported to Statistical Package for Social Software version 26. To find the variables associated with the cancellation of elective surgeries, binary and multi-variable logistic regression analyses were conducted. In the binary analysis, all variables with a p-value of less than 0.25 were included in the multivariable analysis. Finally, a 0.05 p-value with a 95% confidence interval and an adjusted odds ratio was used to declare a significant association. This study included 378 patients scheduled for elective surgeries. Among those, 35.2% of the surgeries were canceled (95% confidence interval: 29.4-39.6). Being female (adjusted odds ratio: 2.46; 95% confidence interval: 1.44-4.203), lack of formal education (adjusted odds ratio: 2.03; 95% confidence interval: 1.15-3.58), place of residence (adjusted odds ratio: 1.70; 95% confidence interval: 1.03-2.81), increase in blood pressure (adjusted odds ratio: 5.09; 95% confidence interval:1.90-13.59), and ophthalmologic surgery (adjusted odds ratio: 3.76; 95% confidence interval: 1.41-10.0) were factors associated with the cancellation of elective surgeries. In this study, nearly one third of scheduled elective surgery was canceled. The primary contributing variables to the surgery cancellations were being female, lack of formal education, place of residence, ophthalmologic surgery, and increased blood pressure. Therefore, timely evidence-based reporting through the supervision team was advised to decrease cancellations.

Rural implementation of the perioperative surgical home: A case-control study.

Perioperative surgical home (PSH) is a novel patient-centric surgical system developed by American Society of Anesthesiologist to improve outcomes and patient satisfaction. PSH has proven success in large urban health centers by reducing surgery cancellation, operating room time, length of stay (LOS), and readmission rates. Yet, only limited studies have assessed the impact of PSH on surgical outcomes in rural areas. To evaluate the newly implemented PSH system at a community hospital by comparing the surgical outcomes using a longitudinal case-control study. The research study was conducted at an 83-bed, licensed level-III trauma rural community hospital. A total of 3096 TJR procedures were collected retrospectively between January 2016 and December 2021 and were categorized as PSH and non-PSH cohorts (n = 2305). To evaluate the importance of PSH in the rural surgical system, a case-control study was performed to compare TJR surgical outcomes (LOS, discharge disposition, and 90-d readmission) of the PSH cohort against two control cohorts [Control-1 PSH (C1-PSH) (n = 1413) and Control-2 PSH (C2-PSH) (n = 892)]. Statistical tests including Chi-square test or Fischer's exact test were performed for categorical variables and Mann-Whitney test or Student's t-test were performed for continuous variables. The general linear models (Poisson regression and binomial logistic regression) were performed to fit adjusted models. The LOS was significantly shorter in PSH cohort compared to two control cohorts (median PSH = 34 h, C1-PSH = 53 h, C2-PSH = 35 h) (P value < 0.05). Similarly, the PSH cohort had lower percentages of discharges to other facilities (PSH = 3.5%, C1-PSH = 15.5%, C2-PSH = 6.7%) (P value < 0.05). There was no statistical difference observed in 90-d readmission between control and PSH cohorts. However, the PSH implementation reduced the 90-d readmission percentage (PSH = 4.7%, C1-PSH = 6.1%, C2-PSH = 3.6%) lower than the national average 30-d readmission percentage which is 5.5%. The PSH system was effectively established at the rural community hospital with the help of team-based coordinated multi-disciplinary clinicians or physician co-management. The elements of PSH including preoperative assessment, patient education and optimization, and longitudinal digital engagement were vital for improving the TJR surgical outcomes at the community hospital. Implementation of the PSH system in a rural community hospital reduced LOS, increased direct-to-home discharge, and reduced 90-d readmission percentages.

Feasibility of intraoperative continuous glucose monitoring: An observational study in general surgery patients

BackgroundPerioperative hyperglycemia is associated with adverse outcomes in surgical patients, and major societies recommend intraoperative monitoring and treatment targeting glucose <180–200 mg/dL. However, compliance with these recommendations is poor, in part due to fear of unrecognized hypoglycemia. Continuous Glucose Monitors (CGMs) measure interstitial glucose with a subcutaneous electrode and can display the results on a receiver or smartphone. Historically CGMs have not been utilized for surgical patients. We investigated the use of CGM in the perioperative setting compared to current standard practices. MethodThis study evaluated the use of Abbott Freestyle Libre 2.0 and/or Dexcom G6 CGMs in a prospective cohort of 94 participants with diabetes mellitus undergoing surgery of ≥3 h duration. CGMs were placed preoperatively and compared to point of care (POC) BG checks obtained by capillary samples analyzed with a NOVA glucometer. Frequency of intraoperative blood glucose measurement was at the discretion of the anesthesia care team, with a recommendation of once per hour targeting BG of 140–180 mg/dL. Of those consented, 18 were excluded due to lost sensor data, surgery cancellation, or rescheduling to a satellite campus resulting in 76 enrolled subjects. There were zero occurrences of failure with sensor application. Paired POC BG and contemporaneous CGM readings were compared with Pearson product-moment correlation coefficients, and Bland-Altman plots. ResultsData for use of CGM in perioperative period was analyzed for 50 participants with Freestyle Libre 2.0, 20 participants with Dexcom G6, and 6 participants with both devices worn simultaneously. Lost sensor data occurred in 3 participants (15%) wearing Dexcom G6, 10 participants wearing Freestyle Libre 2.0 (20%) and 2 of the participants wearing both devices simultaneously. The overall agreement of the two CGM's utilized had a Pearson correlation coefficient of 0.731 in combined groups with 0.573 in Dexcom arm evaluating 84 matched pairs and 0.771 in Libre arm with 239 matched pairs. Modified Bland-Altman plot of the difference of CGM and POC BG indicated for the overall dataset a bias of −18.27 (SD 32.10). ConclusionsBoth Dexcom G6 and Freestyle Libre 2.0 CGMs were able to be utilized and functioned well if no sensor error occurred at time of initial warmup. CGM provided more glycemic data and further characterized glycemic trends more than individual BG readings. Required time of CGM warm up was a barrier for intraoperative use as well as unexplained sensor failure. CGMs had a fixed warm of time, 1 h for Libre 2.0 and 2 h for Dexcom G6 CGM, before glycemic data obtainable. Sensor application issues did not occur. It is anticipated that this technology could be used to improve glycemic control in the perioperative setting. Additional studies are needed to evaluate use intraoperatively and assess further if any interference from electrocautery or grounding devices may contribute to initial sensor failure. It may be beneficial in future studies to place CGM during preoperative clinic evaluation the week prior to surgery. Use of CGMs in these settings is feasible and warrants further evaluation of this technology on perioperative glycemic management.

Elective Surgery Cancellation in A Hospital Setting: A Review

Elective Surgery Cancellation in A Hospital Setting: A Review

Beyond guideline knowledge: a theory-based qualitative study of low-value preoperative testing

BackgroundChoosing Wisely Canada and most major anesthesia and preoperative guidelines recommend against obtaining preoperative tests before low-risk procedures. However, these recommendations alone have not reduced low-value test ordering. In this study, the theoretical domains framework (TDF) was used to understand the drivers of preoperative electrocardiogram (ECG) and chest X-ray (CXR) ordering for patients undergoing low-risk surgery (‘low-value preoperative testing’) among anesthesiologists, internal medicine specialists, nurses, and surgeons.MethodsUsing snowball sampling, preoperative clinicians working in a single health system in Canada were recruited for semi-structured interviews about low-value preoperative testing. The interview guide was developed using the TDF to identify the factors that influence preoperative ECG and CXR ordering. Interview content was deductively coded using TDF domains and specific beliefs were identified by grouping similar utterances. Domain relevance was established based on belief statement frequency, presence of conflicting beliefs, and perceived influence over preoperative test ordering practices.ResultsSixteen clinicians (7 anesthesiologists, 4 internists, 1 nurse, and 4 surgeons) participated. Eight of the 12 TDF domains were identified as the drivers of preoperative test ordering. While most participants agreed that the guidelines were helpful, they also expressed distrust in the evidence behind them (knowledge). Both a lack of clarity about the responsibilities of the specialties involved in the preoperative process and the ease by which any clinician could order, but not cancel tests, were drivers of low-value preoperative test ordering (social/professional role and identity, social influences, belief about capabilities). Additionally, low-value tests could also be ordered by nurses or the surgeon and may be completed before the anesthesia or internal medicine preoperative assessment appointment (environmental context and resources, beliefs about capabilities). Finally, while participants agreed that they did not intend to routinely order low-value tests and understood that these would not benefit patient outcomes, they also reported ordering tests to prevent surgery cancellations and problems during surgery (motivation and goals, beliefs about consequences, social influences).ConclusionsWe identified key factors that anesthesiologists, internists, nurses, and surgeons believe influence preoperative test ordering for patients undergoing low-risk surgeries. These beliefs highlight the need to shift away from knowledge-based interventions and focus instead on understanding local drivers of behaviour and target change at the individual, team, and institutional levels.

Introducing a structured daily multidisciplinary board round to safely enhance surgical ward patient flow in the bed shortage era: a quality improvement research report

Hospital bed shortage is a worldwide concern. Their unavailability has caused elective surgery cancellations at our hospital peaking in spring 2016 at over 50%. This is often due to difficult...

Reducing last-minute cancellations of elective urological surgery-effectiveness of specialist nurse preoperative assessment.

Last-minute cancellations in urological surgery are a global issue, resulting in the wastage of resources and delays to patient care. In addition to non-cessation of anticoagulants and inadequately treated medical comorbidities, untreated urinary tract infections are a significant cause of last-minute cancellations. This study aimed to ascertain whether the introduction of a specialist nurse clinic resulted in a reduction of last-minute cancellations of elective urological surgery as part of our elective recovery plan following the Coronavirus disease 2019, the contagious disease caused by severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2 pandemic. A specialist urology nurse-led clinic was introduced to review urine culture results preoperatively. Specialist nurses contacted patients with positive urine cultures and their general practitioners by telephone and email to ensure a minimum of 2 days of 'lead-in' antibiotics were given prior to surgery. Patients unfit for surgery were postponed and optimized, and vacant slots were backfilled. A new guideline was created to improve the timing and structure of the generic preassessment. Between 1 January 2021 and 30 June 2021, a mean of 40 cases was booked each month, with average cancellations rates of 9.57/40 (23.92%). After implementing changes on 1 July 2021, cancellations fell to 4/124 (3%) for the month. On re-audit, there was a sustained and statistically significant reduction in cancellation rates: between 1 July 2021 and 31 December 2021 cancellations averaged 4.2/97.5 (4.3%, P < .001). Two to nine (2%-16%) patients were started on antibiotics each month, while another zero to two (0%-2%) were contacted for other reasons. The implementation of a specialist urology nurse-led preassessment clinic resulted in a sustained reduction in cancellations of last-minute elective urological procedures.

Resident Burnout Trends During COVID-19: A Retrospective Observational Study

This study was designed to assess the effects of the coronavirus disease pandemic on job satisfaction (JS) and burnout among surgical sub-specialty residents. This is a retrospective, observational, survey-based study. We administered a web-based questionnaire to surgical sub-specialty residents, and results were compared to a prior study in 2016. The questionnaire included elements on demographics, JS, burnout, and self-care habits. Basic statistical analyses were used to compare data from 2020 and 2016. This study takes place at Robert Wood Johnson University Hospital, a single mid-sized New Jersey-based academic institution. This survey was sent to all obstetrics and gynecology and general surgery residents from every postgraduate year based out of our institution. The survey was sent to a total of 50 residents across the 2 programs. Forty total residents responded to the survey, with a response rate of 80%. JS was significantly higher in 2020 than 2016 (p < 0.001). There were no differences between postgraduate years for 2020 or 2016 in emotional exhaustion (p = 0.29, p = 0.75), personal accomplishment (p = 0.88, p = 0.26), or depersonalization (p = 0.14, p = 0.59) burnout scores. A total of 0% of residents in 2020 worked fewer than 61 hours per week. Residents in 2020 exercised more (40.0% vs 21.6%), had similar alcohol usage (60%), and had similar diets to residents in 2016. Residents in 2020 were less likely to regret their specialty (7.5% vs 21.6%), consider changing residencies (30.0% vs 37.8%), or consider a career change (15.0% vs 45.9%). JS scores were significantly higher during the coronavirus disease pandemic. The cancellation of elective surgeries led to a lighter workload for surgical residents. Residents were uncertain of their role during the pandemic, however, new stressors encouraged residents to seek alternative methods for personal wellness.

Baseline factors and reason for cancellation of elective ophthalmic surgery.

To determine the baseline risk factors for elective ophthalmic surgery cancellations and characterise the reasons for cancellation. This is a retrospective, non-randomised study performed at a large tertiary ophthalmic centre. It included a consecutive sample of patients above the age of 18 who had an ophthalmic surgery scheduled at Cole Eye Institute, Cleveland Clinic, OH between January 2012 and December 2019. An automated search pull identified 75,908 scheduled surgeries (63,987 completed and 11,921 cancelled surgeries). Statistical analysis was performed using R (version 3.5.1). Main outcome measures were baseline factors that impact risk for surgery cancellation and reasons for surgery cancellation. Analysis was performed on 69,963 scheduled surgeries (57.37% Female, 42.63% Male; Mean age of 62.72 years; 59,959 completed and 10,004 cancelled surgeries). Of the 2384 cancelled surgeries with reasons provided, the most common causes of cancellation were patient refusal (38.42%), patient health condition (18.79%), and rescheduling of surgery (15.27%). Female sex, black race, patient age less than 50 years, non-cataract surgeries, regional mean household income greater than $82,900, Medicare insurance, and geographical distance of less than 10 miles from home to the surgery site were each associated with a significantly increased risk of surgery cancellation (p < 0.01). This study successfully identified several baseline factors predicting elective ophthalmic surgery cancellation. The clinical insights gained from these lines of enquiry may be used to construct models that not only identify patients at greater risk for cancellation but also highlight which interventions have greatest efficacy in preventing ophthalmic surgery cancellations.