Cancellation Of Surgery Research Articles

Relationship Between Sleep Quality and Blood Pressure Pre Posterior Vitrectomy Patient

Background: Sleep patterns have the highest influence on the incidence of hypertension compared to other variables, namely age and gender. The delay in elective surgery was mostly due to medical factors and mostly due to acute changes in cardiovascular and respiratory functions, abnormal laboratory values and patients refusing surgery. In patients with eye disease, especially in the retina with a Posterior Vitrectomy surgery plan, patients often encounter comorbidities such as hypertension. Incidents of cancellation of elective eye surgery on the day of surgery at the National Eye Center of Cicendo Eye Hospital are also common, especially for reasons of hypertension. Objective: The purpose of this study was to determine the relationship between sleep quality and blood pressure of pre-Posterior Vitrectomy patients at the National Eye Center at Cicendo Eye Hospital, Bandung. Methods: The research method used in this research is analytic observational with cross sectional design. Sampling was carried out at the National Eye Center, Cicendo Eye Hospital, and Bandung. The sampling technique used purposive sampling with a total sample of 114 people. Statistical test with Chi Square Test using SPSS. Result: The results show a p value of 0.003 where the result is smaller than 0.05. From these results, it can be concluded that there is a relationship between the two variables, namely “Sleep Quality” with “Blood Pressure” pre-Posterior Vitrectomy patients at the National Eye Center of Cicendo Eye Hospital Bandung. Conclusion: There is a relationship between sleep quality and blood pressure in pre-posterior vitrectomy patients at the National Eye Centre at Cicendo Eye Hospital, Bandung.

Prioritization of Scheduled Surgeries Using Fuzzy Decision Support and Risk Assessment Methods

The aim of this study was to develop a method to minimize the risk of cancellation of planned surgery in hospital orthopedic departments. The paper proposes a method that combines multi-criteria and multi-faceted risk assessment. Two data sources are used: a fuzzy FTOPSIS method, combined with FMEA assessment. The FMEA method presented in this paper uses the technique of prioritizing preferences according to FTOPSIS similarity to the ideal solution and belief structure, in order to overcome the shortcomings of traditional FMEA indicators. Finally, a numerical case study of process optimization for elective surgery in a Polish clinic is presented. The focus was on planned hip replacements. The effectiveness of the method in assessing the main factors influencing cancellation of elective surgery is demonstrated. A high accuracy of the results and wide adaptability of the method to other areas are features of the combination of the abovementioned methods. The problem addressed in this publication is the high rate of cancellation of elective surgery. The selection of relevant criteria, their importance, and the preferences of the patients were studied. The results of the method provide a viable action plan for the proposed research problem. The proposed method is multifaceted and can be part of an information system to support reorganization, restructuring, and modification of an operational process.

How to Reduce the Cardiac Risk, One of the Most Common Perioperative Complications Following Invasive Surgery in Gynecology

The role of preoperative cardiac evaluation is to determine the medical condition of the patient's cardiovascular status .A history and cardiovascular examination are crucial to identify severe cardiac conditions such as unstable coronary syndromes, serious arrhythmias, decompensated HF, and valvular disease. These conditions would place the patient in a high surgical risk category. In some situations, an additional diagnostic cardiac evaluation is necessary on the basis of the results of the initial preoperative test. In an acute surgical emergency, preoperative evaluation might have to be limited to simple tests, such as a rapid assessment of cardiovascular vital signs, ECG, blood pressure, hematocrit, electrolytes, renal function, blood analysis. Only the most essential tests and interventions are appropriate until the acute surgical emergency is resolved. Under other, less urgent circumstances, the preoperative cardiac evaluation may lead to a variety of responses, including delay or cancellation of surgery until the cardiac problem has been clarified and treated appropriately. This ideally would include direct communication with the surgeon, anaesthesiologist, and other physicians, as well as discussion directly with the patient and, if appropriate, the family. Conclusion: Preoperative cardiac evaluation is very important for all the patients undergoing gynaecologic surgery because cardiac related perioperative complications are well-known in general practice.

Trends of Ophthalmic Surgery Cancellations at a County Hospital Before and During COVID-19: A 10-Year Retrospective Study

ABSTRACT Purpose Despite several publications on ophthalmic surgical cancellations discussing preventative causes in academic institutions, there remains a paucity of similar studies for safety-net hospitals. This study analyzed cancellation rates at a county hospital over a 10-year period. Methods This retrospective, open cohort study investigated a total of 11,350 surgeries scheduled at a tertiary-level county hospital between January 1, 2012 and December 31, 2021. Surgical cancellation reasons were collected from chart review and categorized into eight groups to allow for analyses. Cancellation rates were then calculated per year and per subspecialty. The primary statistical analyses were paired, 2-tailed t test and χ2 test. Results The most common reason for cancellation overall was institution-related (1065 surgeries), which was also the most common reason per year from 2012 to 2019 (range: 37.4% − 60.6%). In 2020, during COVID-19 stay-at-home mandates, the most common reason became COVID-related rescheduling, and in 2021, it was patient-driven. The cancellation rate in 2020 was significantly higher than 2019 (+9.27%,95% CI:4.96%-13.6%,p = .05), and significantly lower from 2021 to 2020 (−22.8%,95% CI:-26.8%-(-)18.7%,p = .001). Pediatric surgery had the highest cancellation rate overall (36.4%), but oculoplastics had the highest cancellation rate in 2020 (48.9%). Conclusion The most common reason for cancellation over the 10-year period was institution-related, in contrast to other publications based in academic centers. The study also had a higher cancellation rate than previously reported, again suggesting the difference between county and academic centers. The COVID-19 pandemic had a significant impact on cancellations, even after the COVID-19 stay-at-home orders were eased.

Exploring the rate and reasons for same-day cancellation of cardiac surgery after implementing joint commission international standards: a retrospective cross-sectional study

BackgroundSame-day cancellation of cardiac surgery significantly impacts operating room management efficiency, which can be mitigated by taking preventive measures. This study aimed to explore the same-day cancellation rate of elective adult cardiac surgery, as well as the reasons for those cancellations. A retrospective cross-sectional study reviewed the records of 581 scheduled elective adult cardiac surgical cases at a single cardiac center from June 2017 to May 2018. The same-day cancellation reasons were grouped into four broad categories: nonclinical cancellations, clinical cancellations, patient-related cancellations, and 'other reason' cancellations. A case was considered canceled when it was not performed on the same day as the planned surgery.ResultsA total of 581 elective adult cardiac surgeries were scheduled during the study period, and 56 (9.63%) of these were canceled. The highest cancellation rate was due to nonclinical cancellations, with 39% of scheduled cases, followed by clinical cancellations, with a 34% cancellation rate. Patient-related cancellations accounted for 23% of cancellations, while the lowest rate was due to ‘other reasons,’ which accounted for 4% of total cancellations. The most common reason for nonclinical cancellations was the inclusion of emergency cases (n = 8; 14%). The most common reason for clinical cancellations was changes in the patient’s medical condition (n = 8, 14%). The common reason for patient-related cancellations was the refusal of surgery (n = 9; 16%). The lowest rate was for menstruating female patients (n = 2; 4%).ConclusionsThe same-day cancellation rate was 9.36%, and most of the cancellation reasons could be mitigated by implementing preventive strategies to improve the efficiency of the operating room. Preoperative preparation clinics and paying particular attention to female patients scheduled for surgery might reduce the rate of elective cardiac surgery cancellation.

13 years of hand surgery without an anesthesiologist. An analysis of efficacy and safety of presurgical anesthesia as delivered by surgeons without the assistance of anesthesiologists.

<b><br>Introduction:</b> The assistance of anaesthesiologist is considered an inseparable part of most surgical procedures, with the exception of a small proportion of minor procedures performed under local anaesthesia. In hand surgery, a vast majority of procedures, even those lasting several hours, can be carried out under regional (brachial plexus block) or local (infiltration) anaesthesia. These can be delivered by the surgeons themselves, allowing the surgeries to be carried out without the assistance of anesthesiologists.</br> <b><br>Aim:</b> The aim of this study was to analyze the efficacy and safety of presurgical anesthesia as delivered by surgeons without the assistance of anesthesiologists in the course of hand surgery procedures performed within the institution headed by the author of this article.</br> <b><br>Material and methods:</b> The analysis was based on the records of anesthesia protocols filled out by the surgeons who delivered the anesthesia and who operated on the patients. The variables considered included the efficacy of anesthesia and the anesthesia-related adverse effects and complications.</br> <b><br>Results:</b> Over a period of 13 years (2010-2022), a total of 24,703 surgeries were delivered; of these, 22,228 (91%) surgeries were carried out without anesthesiologists, with anesthesia being delivered by the surgeon him/herself. The efficacy of these procedures (local anasthesia and brachial plexus blocks combined) was 99%. A total of 631 (2.8%) anesthesia-related adverse reactions were recorded, most of them being transient, requiring immediate interventions and not leading to any serious sequelae. In only 17 cases (0.07%), adverse effects resulted in cancellation and rescheduling of the elective surgery.</br> <b><br>Conclusions:</b> Pre-surgical anesthesia as delivered prior to hand surgery procedures by the surgeons without the assistance of anesthesiologists is effective and safe while being associated with numerous benefits for patients, surgeons and the health care system's budget.</br&gt.

Predictive analytics for cardio-thoracic surgery duration as a stepstone towards data-driven capacity management

Effective capacity management of operation rooms is key to avoid surgery cancellations and prevent long waiting lists that negatively affect clinical and financial outcomes as well as patient and staff satisfaction. This requires optimal surgery scheduling, leveraging essential parameters like surgery duration, post-operative bed type and hospital length-of-stay. Common clinical practice is to use the surgeon’s average procedure time of the last N patients as a planned surgery duration for the next patient. A discrepancy between the actual and planned surgery duration may lead to suboptimal surgery schedule. We used deidentified data from 2294 cardio-thoracic surgeries to first calculate the discrepancy of the current model and second to develop new predictive models based on linear regression, random forest, and extreme gradient boosting. The new ensamble models reduced the RMSE for elective and acute surgeries by 19% (0.99 vs 0.80, p = 0.002) and 52% (1.87 vs 0.89, p < 0.001), respectively. Also, the elective and acute surgeries “behind schedule” were reduced by 28% (60% vs. 32%, p < 0.001) and 9% (37% vs. 28%, p = 0.003), respectively. These improvements were fueled by the patient and surgery features added to the models. Surgery planners can benefit from these predictive models as a patient flow AI decision support tool to optimize OR utilization.

To err is human: A healthcare organization blueprint towards safety and reliability.

392 Background: In 2019, a comprehensive cancer center was audited by a regulatory agency that identified opportunities to improve the safe delivery of healthcare. Even though the organization has been engaged in multiple continuous improvement initiatives, we found that to run a complex enterprise efficiently, we needed to break silos, learn from the frontline, and educate and train leaders in a psychologically safe environment. The overarching goal is to improve our culture of safety by developing a safety-focused workforce, improving robust processes around high-harm events, increasing transparency/feedback regarding safety events, and advancing the institution towards a High Reliability Organization (HRO)1 with zero preventable patient harm. Methods: Key interventions implemented: 1. Revamped our Root Cause Analysis; 2. Developed a Quality Assurance Performance Improvement (QAPI)2 council with leadership from the enterprise and representatives of the Patient Family Advisory Program, patients of the organization; 3. Implemented a Tiered Readiness Briefing (TRB) 7 days a week; 4. Selection of Serious Safety Event Rate (SSER)3 as the organization's measurement of patient safety and made it transparent; 5. Implementation of a mandatory training program in HRO skills and tools necessary to change behaviour. Training of leadership first goal was to get their buy-in so that the rest of the workforce would comply with the training; 6. Created Priority Focus Areas (PFA) initiatives supported by QAPI, the board, and leadership- providing resources to improve widespread, problem-prone, high-risk issues. Also, a system of accountability. Results: From June 2020 to April 2023- 59% reduction on SSER and sustained rate &lt;0.9; 96% of leaders and 86% of medical faculty trained in HRO; 100% of “Start the Clock” issues identified in TRB are acted on within 24 hrs.; PFA success: the creation of the Blood Shortage Safety Decision Matrix- resulted in no surgery cancellation due to blood shortage. Conclusions: Rigorously implementing HRO principles in a comprehensive and complex cancer center resulted in improved process outcomes and patient safety outcomes that significantly reduced serious safety events.

Preoperative admission is non-essential in most patients receiving elective laparoscopic cholecystectomy: A cohort study.

We evaluated conventional overnight-stay laparoscopic cholecystectomy, focusing on the preoperative admission day, to assess the feasibility of implementing daycare laparoscopic cholecystectomy, which is currently underutilized in developing and some Asian countries. We retrospectively reviewed elective laparoscopic cholecystectomy data from March 2020 to February 2022 at a 700-bed tertiary hospital in Thailand. Variables included age, sex, body mass index, comorbidities, American Society of Anesthesiologists status, presence of preoperative anesthesiology visit, laparoscopic cholecystectomy indications, additional intraoperative cholangiography, and surgery cancellations. The primary focus was on preoperative treatment and monitoring needs; secondary outcomes included morbidity, mortality within 30 days, and prolonged hospital stay (>48 hours). Statistical analysis was conducted using the Fisher exact test, t-test, and logistic regression. The study included 405 patients. Of these, 65 (16.1%) received preoperative treatment, with 21 unnecessary (over) treatments and six under-treatments. Based on the results, approximately 12.1% (n = 49) of patients may have theoretically required preoperative admission and treatment. Multivariable analysis showed that the increasing of comorbidities was significantly associated with preoperative management (odds ratio [95% Confidence interval]: 7.0 [2.1, 23.1], 23.9 [6.6, 86.6], 105.5 [17.5, 636.6]) for one, two, and three comorbidities, respectively), but factors such as age, obesity, and American Society of Anesthesiologists status were not. The cohort had 4.2% morbidity (2.2% medical complications), with no mortality. Surgery cancellations occurred in 0.5%. In conclusion, on the basis of our data, a small proportion (12.1%) of patients undergoing elective laparoscopic cholecystectomy may require preoperative admissions to receive the necessary treatment, and most (87.9%) preoperative admissions may not provide treatment benefit. The traditional admission approach was safe but required re-evaluation for optimal resource management.

Elective joint surgeries were safe and effective during the COVID-19 pandemic: a retrospective cohort study in Washington State

Introduction The cancelation of elective joint procedures left patients affected with debilitating osteoarthritis unsure of when their joint replacement operation would take place. Our primary aim in this study was to assess the safety of total hip and knee arthroplasty (THA, TKA) during an active pandemic and to determine if patient outcomes changed after a State of Emergency declaration. Methods This retrospective cohort study evaluated the outcomes of patients who received a THA or TKA in Yakima County, a region in Washington State which had the most COVID-19 infections per capita at the time of the initial surge in 2020. Patients were stratified between a control group and COVID-19 group depending on if their surgery was before or after the cancellation of all elective surgeries on March 19th, 2020. Demographics, surgical notes, COVID-19 test status, functional outcomes, and adverse events were collected. Chi-square and t-tests were utilized to analyze differences between categorical and continuous variables, respectively. Results Inclusion criteria was met for 90 patients for the control group and 490 patients for the COVID-19 group. There were no differences between the cohorts in age, BMI, ethnicity, Charlson Comorbidity Index scores, insurance status, or procedure type. There were four recorded COVID-19 infections from patients in the COVID-19 group (p=0.39); zero of which had complications related to their postoperative care. In comparing our control group to COVID-19 group, no significant differences were observed in postoperative emergency room visits (2.2% vs 6.3% respectively (p=0.126)), hospital readmissions ( 2.2% vs 3.9% respectively (p=0.447)), or any adverse events ( 5.6% vs 7.3% respectively (p=0.073)). Visual analogue pain scores, Lower Extremity Functional scores, and range of motion at one week and three months postoperative were not significantly different between either group. Discussion Our comparison between these patient cohorts showed no significant differences in the rate of postoperative adverse events, functional outcome scores, or complications from COVID-19 infections. Thus, with the proper precautions, elective joint replacement surgery may be done safely during a State of Emergency declaration for an active pandemic.

Rethinking referral systems in rural chiapas: A mixed methods study

BackgroundDespite the assurance of universal health coverage, large disparities exist in access to surgery in the state of Chiapas. The purpose of this study was to determine the effectiveness of the surgical referral system at hospitals operated by the Ministry of Health in Chiapas. Methods13 variables were extracted from surgical referrals data from three public hospitals in Chiapas over a three-year period. Interviews were performed of health care workers involved in the referral system and surgical patients. The quantitative and qualitative data was analyzed convergently and reported using a narrative approach. FindingsIn total, only 47.4% of referred patients requiring surgery received an operation. Requiring an elective, gynecological, or orthopedic surgery and each additional surgery cancellation were significantly associated with lower rates of receiving surgery. The impact of gender and surgical specialty, economic fragility of farmers, dependence upon economic resources to access care, pain leading people to seek care, and futility leading patients to abandon the public system were identified as main themes from the mixed methods analysis. InterpretationSurgical referral patients in Chiapas struggle to navigate an inefficient and expensive system, leading to delayed care and forcing many patients to turn to the private health system. These mixed methods findings provide a detailed view of often overlooked limitations to universal health coverage in Chiapas. Moving forward, this knowledge must be applied to improve referral system coordination and provide hospitals with the necessary workforce, equipment, and protocols to ensure access to guaranteed care. FundingHarvard University and the Abundance Fund provided funding for this project. Funding sources had no role in the writing of the manuscript or decision to submit it for publication.

Incidence and root causes of surgery cancellations at an academic medical center in Iran: a retrospective cohort study on 29,978 elective surgical cases

IntroductionCanceling scheduled surgeries on the day of surgery places a heavy burden on healthcare providers and has psychological, social, and financial consequences on patients and their families. This study aimed to investigate the main reasons for cancellations of elective procedures and provide appropriate recommendations to reduce the rate of such avoidable cancellations.MethodsData were collected retrospectively from all consecutive elective cases scheduled for various elective surgeries from January 1, 2020 to March 31, 2022 at Namazi Teaching Hospital, a major referral center in southern Iran with a capacity of 938 beds. Daily data were collected on the number of planned electives, cancellations, and reasons for cancellations. Surgical cancellation reasons were categorized as patient-related, surgeon-related, hospital/system-related, and anesthesia-related. Data were expressed as frequency (percentage) and analyzed with SPSS version 19 software.ResultsThe cancellation rate on surgery day for elective procedures in all fields was 6.3%. The highest cancellation rate was related to minor surgeries (19%), followed by urology (8%), pediatrics (7%), and plastic surgery (7%). The most common reasons for cancellation were patients not suitable for the procedure (37%), followed by patients who did not follow instructions (10%), lack of time (10.5%), and equipment/supplies problems (10%), and refusal to consent (6%).ConclusionsAccording to this study, patients’ unsuitability for surgery, non-compliance with instructions, lack of time, and problems with equipment/supplies are the main reasons for canceling surgery. Proper preoperative assessment and preparation of patients and improved communication between medical teams and patients reduce the cancellation of booked surgeries.

Predictors of same day cancellation of elective surgery.

Same day cancellations of surgery have adverse effects on both patients and health care systems. To date, the majority of research has evaluated reasons for same day cancellation, and relatively little is known about risk factors for cancellation. The aim of this study is to develop and evaluate the accuracy of a model for preoperatively predicting which patients are at risk for experiencing same day cancellation. While accurately predicting which patients are likely to experience same day cancellation remains challenging, predictive models may aid in the early identification of patients at risk for cancellation. Future studies are required to assess whether the use of predictive analytics leads to reduced cancellation rates in practice.

Cancellation of Elective Oral and Maxillofacial Surgery, a Tertiary Hospital Experience.

Cancellation of elective surgery is said to occur when a patient's name appears on the operation list, but the operation is not done on the intended date. Cancelling elective surgeries is a long-standing problem faced by many countries worldwide. Reasons for cancellation of surgery vary from one hospital to another. The goal of this study was to identify factors associated with the cancellation of scheduled Oral and maxillofacial surgeries in the Lagos State University Teaching Hospital. Cancellations of elective scheduled operations from January 2021 to July 2022 were reviewed retrospectively. All cancellations were recorded in a predesigned form which included information about the age of the patient, hospital identification number, date of cancellation, type of operation, the Surgeon and the Anaesthetist, preoperative anaesthetic evaluations, any associated medical problems and the presumed reasons for cancellations for in-patients and day case surgery. Patients who died before the time of their scheduled surgery were excluded. 80 patients had their operation cancelled on the day of surgery, and the rate of cancellations was 44.2%. The most common causes of cancellations were patient-related (50%), accounting for up to half of the cancellations. The major reason for cancellation under the administrative category was insufficient time in the theatre to complete the operation list (18.8%). Financial constraint (16.3%) on the day of the surgery was noted more among planned day case procedures and delayed laboratory results (12.5%); oftentimes, covid test results were the major reasons for cancellations under the patient-factors category. The rate of cancellation in this study was high, most of which are patients related. Administrative-related reasons were also identified. However, in most cases, these cancellations can be avoided.

Elective surgery cancellations due to suboptimal medicine management: a retrospective single site study

AbstractBackgroundElective surgery cancellations and delays are associated with negative financial and staffing ramifications, adverse clinical outcomes, and poor patient outcomes. The Princess Alexandra Hospital in Brisbane, Australia, performs approximately 15 000 elective surgeries per year and medication optimisation is pivotal in preparing a patient for surgery to avoid same day of surgery theatre cancellations. Ideally, patients are seen in a multidisciplinary pre‐admission clinic for optimisation of their health and medicines, and to provide education regarding their surgery.AimTo calculate the incidence of elective surgery cancellations due to medication misadventure over a 12‐month period.MethodA retrospective audit at a tertiary Queensland Hospital was conducted over a 12‐month period (April 2021–March 2022), including patients who had their elective surgeries cancelled. The medical records from the hospital's digital databases for patients who were identified by the hospital coding service as ‘unfit for surgery’ were screened to see if the reason for the surgery cancellation was due to medication misadventure. The project was reviewed by the Metro South Human Research Ethics Committee and deemed exempt from further review (Ref No: CM20221651).ResultsThe surgery cancellation rate was 50% (n = 6626 cancelled surgeries from 13 255 total surgeries booked). The same day of surgery cancellation rate was 5.5% (n = 734). Medication misadventure resulting from suboptimal medicine management was responsible for 1% (n = 66 out of 6626 surgery cancellations). A total of 41% (n = 27) of patients had their surgery cancelled ahead of time by the pharmacist due to a medication not being withheld for long enough, which prevented a same‐day cancellation.ConclusionHaving a pre‐admission clinic pharmacist improves preoperative medication optimisation and has been proven to avoid same‐day cancellations.

Telephone assessment of new hernia referrals-is it possible?

Utilisation of remote clinics is increasing in healthcare settings worldwide. During the height of the COVID pandemic, our UK-based teaching hospital has trialled telephone assessment for new patients presenting with primary hernias. Selected cases are listed for elective repair of primary hernia direct from telephone clinic assessment. In March 2021, after this process had been in place for 13months, departmental triage criteria were introduced, allocating patients to initial assessment in Face to Face or Telephone Clinics. Here, we evaluate the effectiveness of telephone assessment, with specific attention to 'Day of Surgery' cancellation. We also assess the effect of our triage criteria on rate of 'Day of Surgery' cancellation. Departmental diaries were studied retrospectively to identify patients listed for hernia repair between February 2020 and February 2022. Data were obtained from clinic letters, discharge paperwork and operating lists, as well as from management teams. Fishers Exact test was used to compare groups seen either face to face or remotely as well and pre- and post-intervention. 325 patients were listed for hernia repair, 56 after telephone assessment. 6 (11%) of those listed from telephone clinic were cancelled on the day of surgery, compared with 34 (13%) of those seen face to face. With triage criteria in place, listing from telephone clinic increased significantly from 14 to 27%. Overall day of surgery cancellations reduced from 13 to 9%. Rate of day of surgery cancellation in those assessed in telephone clinic reduced from 12 to 9%. There is no significant difference between day of surgery cancellations after face to face or telephone clinic assessment. Triage criteria for telephone assessment appear to increase the numbers being listed after remote clinics. This did not significantly impact the number of day of surgery cancellations.

HOCUS POCUS: ultrasound beyond regional anesthesia in the ambulatory setting.

Application of ultrasound in clinical anesthesia practice extends beyond regional anesthesia. In this review, we have discussed other point of care applications of ultrasound in perioperative care and anesthetic management with special emphasis on ambulatory practice. Point of care ultrasound (POCUS) for anesthesiologists has gained widespread interest and popularity. Recent literature has highlighted multiple perioperative POCUS applications on various organ systems and its benefits. We have analyzed the recent available data and evidence for perioperative POCUS, its benefits and limitations in perioperative medicine. Perioperative POCUS skill is a natural extension of ultrasound guided regional anesthesia. Utilizing POCUS in the perioperative period would accelerate the level of appropriate care, safety and improve outcomes in ambulatory centers. More anesthesiologists embracing POCUS would enhance patient care in a timely fashion at the ambulatory centers. POCUS in ambulatory practice can be valuable in avoiding delay or cancellation of surgeries and improving patient satisfaction.

How does trauma secondary to unexpected extreme weather affect orthopaedic surgery departments? An epidemiological study on the Filomena snowstorm.

Trauma secondary to extreme weather events may heavily impact the normal activity of orthopaedic surgery departments, especially in places not prepared to deal with them. The Filomena snowstorm, which happened in January 2021, has been one of the greatest snowstorms ever in Spain. During it, the constant influx of trauma patients made the Orthopaedic Emergencies Department (OED) to collapse. The primary objective of this study was to describe the orthopaedic injuries and changes in fracture's epidemiology observed during this exceptional period. Secondary objectives were to analyse the collected variables in order to minimize the future impact of these unexpected extreme weather events. Retrospective cohort study between patients that came to the OED during the snowstorm (Filomena group) and those who came on the same period of the previous year (Control group). The following data were collected: age, sex, injury location, injury mechanism, diagnosis, AO/OTA fracture classification, treatment type (conservative vs surgical) and delay to surgical treatment. A total of 1237 patients were included in total, 655 patients from the Filomena group and 582 from the Control group. One in two patients in the Filomena group sustained a fracture (50.7% vs 23.2%). The most frequent diagnosis on the Filomena group was distal radius fracture (16.2%), five times more frequent than in the Control group (3.4%). A significant increment was also observed in the incidence of ankle (21.7%) and proximal humerus (33%) fractures. In Filomena, surgically treated fractures increased by 168%, being more severe, as C-type fractures were more prevalent (23% vs 13%). Mean delay to surgery was 6.78days during the snowstorm. Unexpected snowstorms entail an exponential rise in orthopaedic care demand and OED pressures. A significant increment in orthopaedic trauma surgery, up to 168% more, particularly distal radius, proximal humerus and ankle fractures it is to be expected, which will imply elective surgery cancellation, damaging patients and increasing costs.

Elective surgery cancellations in pediatric surgery: rate and reasons

IntroductionCanceling pediatric elective surgery leads to multiple disturbances regarding the inefficient operating room (OR) management, the financial repercussions, and the psychological impact on the patient and his family. This study aims to identify the reasons for cancellations among the pediatric population in our setting and suggest some convenient solutions.MethodsWe carried out a prospective and descriptive study over 12 months in the pediatric surgery department of Fattouma Bourguiba University Hospital.ResultsOne thousand four hundred twenty-six patients were scheduled for surgery at the pediatric surgery department, of whom 131 (9.2%) were canceled. Medical and anesthesia-related reasons accounted for 62.5% of all cancellations, followed by surgical reasons at 16%, organizational or administrative issues at 11.5%, and patient-related reasons at 10%. The most significant causes were upper respiratory tract infections (URTIs) in 36.6%, abnormal blood test results in 16%, and non-adherence to preoperative fasting in 9.2%.ConclusionsThe rate of pediatric elective surgery cancellations at Fattouma Bourguiba University Hospital was higher than the accepted average rate (5%). Therefore, to prevent these cancellations as much as possible, efforts should be made to promote children’s medical care, operation scheduling, and efficient institution resource utilization.

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.