Delivery Of Surgical Care Research Articles

Neurosurgical training in the Caribbean

•Neurosurgical training in the Caribbean has not been well-defined in published data.•Neurosurgical programs are the framework for the delivery of surgical care.•Maldistribution of the neurosurgery workforce is one of the challenges faced.•Facilitating partnerships within the Caribbean would enhance regional solidarity.

P-BN34 A single centre study of outcomes for Hiatal Surgery during the Covid-19 pandemic

BackgroundCovid-19 has had a significant adverse impact on our ability to maintain provision of surgical interventions for a range of conditions, due to the diversion of resources to care for Covid related emergency admissions. Furthermore, there is clear evidence demonstrating how covid-19 infection in the peri-operative period is associated with dramatically increased rates of morbidity for patients. It has therefore become incumbent on healthcare providers to create peri-operative care pathways which can facilitate delivery of surgical care in a Covid safe environment. MethodsIn response to the Covid-19 pandemic our institution implemented a ‘Covid-lite’ pathway in order to allow the admission for patients for surgical procedures on the basis of urgent need. This included patients requiring surgery benign upper GI conditions. Patients underwent pre-operative PCR Covid testing,and asked to isloate from time of swab until admission for surgery. Post-opertive operative care was provided on the elective surgical ward which is is all single rooms, and was maintianed as a Covid free environment. We conducted a review of outcomes for all patients undergoing hiatal procedures between January 2020 – April 2021. Surgeries included were Para-Oesophageal Hernia Repair (POH), Anti-reflux Surgery (ARS) & surgery for achalasia (LCM). The primary outcome measure was the rate of Covid-19 infection in the peri-operative period. Measurements were also taken of length of stay, and any signifcant morbidity.ResultsHiatal surgery was performed on 42 patients in this time period (28 female, 14 male). The median age was 73 years. Three patients underwent elective ARS and 39 had repair of POH. All ARS procedures were performed laparoscopically. For those having POH repair, 31 cases were elective admissions. 30/31 cases had laparoscopic procedures, with 50% of emergency cases also treated laparoscopically. All elective maptients were managed via the The median length of stay for elective cases was 2 days vs. 14.5 for emergencies (p = 0.001). Zero patients returned positive Covid-19 tests pre-operatively or during their inpatient stay. Two patients were re-admitted within 30 days, although neither were related to covid-19.ConclusionsThese results indicate that it is possible to safely maintain the provision of hiatal surgery in the Covid-19 era for both elective and emergency cases. The use of a dedicated pathway demonstrates our ability to minimise risk of peri-operative Covid-19 infection and any associated morbidity or mortality. Although there has been a significant attempt prioritise surgery for patients with cancer during the Covid-19 pandemic, these resuts provide a strong case that it possible to provide safe and timely interventions for other necessary surgical interventions with appropriate risk reducing measures.

811. Impact of the COVID-19 Pandemic on Surgical Volume and Surgical Site Infections (SSI) in a Large Network of Community Hospitals

BackgroundThe COVID-19 pandemic significantly impacted hospitalizations and healthcare utilization. Diversion of infection prevention resources toward COVID-19 mitigation limited routine infection prevention activities such as rounding, observations, and education in all areas, including the peri-operative space. There were also changes in surgical care delivery. The impact of the COVID-19 pandemic on SSI rates has not been well described, especially in community hospitals.MethodsWe performed a retrospective cohort study analyzing prospectively collected data on SSIs from 45 community hospitals in the southeastern United States from 1/2018 to 12/2020. We included the 14 most commonly performed operative procedure categories, as defined by the National Healthcare Safety Network. Coronary bypass grafting was included a priori due to its clinical significance. Only facilities enrolled in the network for the full three-year period were included. We defined the pre-pandemic time period from 1/1/18 to 2/29/20 and the pandemic period from 3/1/20 to 12/31/20. We compared monthly and quarterly median procedure totals and SSI prevalence rates (PR) between the pre-pandemic and pandemic periods using Poisson regression. ResultsPre-pandemic median monthly procedure volume was 384 (IQR 192-999) and the pre-pandemic SSI PR per 100 cases was 0.98 (IQR 0.90-1.04). There was a transient decline in surgical cases beginning in March 2020, reaching a nadir of 185 cases in April, followed by a return to pre-pandemic volume by June (figure 1). Overall and procedure-specific SSI PRs were not significantly different in the COVID-19 period relative to the pre-pandemic period (total PR per 100 cases 0.96 and 0.97, respectively, figure 2). However, when stratified by quarter and year, there was a trend toward increased SSI PR in the second quarter of 2020 with a PRR of 1.15 (95% CI 0.96-1.39, table 1). ConclusionThe decline in surgical procedures early in the pandemic was short-lived in our community hospital network. Although there was no overall change in the SSI PR during the study period, there was a trend toward increased SSIs in the early phase of the pandemic (figure 3). This trend could be related to deferred elective cases or to a shift in infection prevention efforts to outbreak management. Disclosures All Authors: No reported disclosures

Plastic Surgeon Financial Compensation-Incentivization Models in Surgical Care Delivery: The Past, Present, and Future.

Surgeons are critical for the success of any health care enterprise. However, few studies have examined the potential impact of value-based care on surgeon compensation. This review presents value-based financial incentive models that will shape the future of surgeon compensation. The following incentivization models will be discussed: pay-for-reporting, pay-for-performance, pay-for-patient-safety, bundled payments, and pay-for-academic-productivity. Moreover, the authors suggest the application of the congruence model-a model developed to help business leaders understand the interplay of forces that shape the performance of their organizations-to determine surgeon compensation methods applicable in value-based care-centric environments. The application of research in organizational behavior can assist health care leaders in developing surgeon compensation models optimized for value-based care. Health care leaders can utilize the congruence model to determine total surgeon compensation, proportion of compensation that is short term versus long term, proportion of compensation that is fixed versus variable, and proportion of compensation based on seniority versus performance. This review provides a framework extensively studied by researchers in organizational behavior that can be utilized when designing surgeon financial compensation plans for any health care entity shifting toward value-based care.

Assessing the Rates and Reasons of Elective Surgical Cancellations on the Day of Surgery: A Multicentre Study from Urban Indian Hospitals

BackgroundCancellations of elective surgeries on the day of surgery (DOS) can lead to added financial burden and wastage of resources for healthcare facilities; as well as social and emotional problems to patients. These cancellations act as barriers to delivering efficient surgical services. Optimal utilisation of the available resources is necessary for resource-constrained low-and-middle-income countries (LMIC). This study investigates the rate and causes of cancellations of elective surgeries on the DOS in various surgical departments across ten hospitals in India.MethodsA research consortium ‘IndSurg’ led by World Health Organisation Collaboration Centre (WHOCC) for Research in Surgical Care Delivery in LMICs, India conducted this multicentre retrospective cross-sectional study to analyse the cancellations of elective/planned surgical operations on DOS across urban secondary and tertiary level hospitals. We audited surgical records of a pre-decided period of six weeks for cancellations, documented relevant demographic information and reasons for cancellations.ResultsWe analysed records from the participating hospitals, with an overall cancellation rate of 9.7% (508/5231) on the DOS for elective surgical operations. Of these, 74% were avoidable cancellations. A majority (30%) of these 508 cancellations were attributed to insufficient resources, 28% due to patient's refusal or failure to show-up, and 22% due to change in patient's medical status.ConclusionWe saw a preponderance of avoidable reasons for elective surgery cancellations. A multidisciplinary approach with adequate preoperative patient counselling, timely communication between the patients and caregivers, adequate preoperative anaesthetic assessment, and planning by the surgical team may help reduce the cancellation rate.

Redesigning the Process for Scheduling Elective Orthopaedic Surgery: A Combined Lean Six Sigma and Person-Centred Approach.

The Health Service Executive Ireland model of care for elective surgery supports the delivery of elective surgical care in achieving both process and clinical outcomes. This project was conducted in the Orthopaedic Department. Following an outpatient consultation with an orthopaedic surgeon, patients who required surgical intervention were scheduled for their intervention by the administrative team. Prior to commencing this project, the average time from patient consultation to being scheduled for surgery on the hospital system was 62 h/2.58 days. A pre- and post-team-based intervention design employing Lean Six Sigma methodology was applied to redesign the process for scheduling elective orthopaedic surgery. The project was informed by collaborative, inclusive, and participatory stakeholder engagement. The goal was to streamline the scheduling process for elective orthopaedic surgery, with a target that 90% of surgeries are scheduled “right first time” within 48 h/two working days of the outpatient consultant appointment. The main outcome measures showed that 100% of orthopaedic surgeries were scheduled successfully within 2 days of outpatient appointment. Duplication in work between patient services and scheduling teams was eliminated and facilitated a reduction in unnecessary staff workload. This project highlights the importance of collaborative interdisciplinary stakeholder engagement in the redesigning of processes to achieve sustainable outcomes, and the findings have informed further improvements across the hospital’s surgical scheduling system.

Global Surgery and Mercy Ships

Two-thirds of the world population do not have access to safe, affordable and timely surgery. This global surgical crisis largely affects low and middle-income countries, and it will surpass the challenges created by communicable diseases. The barriers of access to surgery range from cost of surgery and patient transportation to availability and quality of surgical infrastructure and providers.Mercy Ships is a Non-Governmental Organisation (NGO) providing free world-class life-saving and life-transforming surgery to the poorest of the poor in West Africa. In order to address barriers to access surgical assessment and care, Mercy Ships switched from centralised patient selection mainly in port cities or capitals to decentralised selection strategy staffed by experienced nursing teams travelling to remote locations nearer to patients' homes. In this way, the under-served rural population is given equal opportunity to access Mercy Ships’ free specialised surgical services.In each country served by the Mercy Ships, a 5 year country engagement program is created to focus on improving the quality of life for people living with disease, disfigurement and disability through free direct medical service to reduce the burden of unmet surgical needs. Moreover, our Medical Capacity Building teams concentrate in improving infrastructure and quality control, equipment donation and maintenance. Lastly, Mercy Ships partner with government and policy makers to improve and strengthen their local surgical care delivery system as an indispensable part of the healthcare system. In this vast sea of global surgical crisis, the vision of the Mercy Ships is to eradicate the ‘disease of poverty’ and effectively do itself out of a job.Mercy Ships' new and the world's largest (37,000 ton) purpose-built hospital ship, the Global Mercy, is joining our current ship, the Africa Mercy (16,500 ton) to save lives and to strengthen local surgical care service. This will more than double our capacity and impact in sub-Saharan Africa following COVID-19 pandemic. Moreover our state-of-art on-board simulation laboratories and traditional practical training of local healthcare providers will further enhance and build their medical capacity. The Global Mercy will become the largest floating and training platform to train next generation African medical and health care professionals so that they can save countless lives by training others in the future. We therefore invite you to partner with us in bringing hope and healing to the forgotten poor in West Africa.

EP.WE.721The effects of COVID-19 on emergency theatre utilisation

AimsThe ongoing COVID-19 pandemic and subsequent lockdown have adversely affected elective care services within the NHS. Emergency Services are also affected to varying extents nationally. Due to deferred elective services our hospital was able to implement two emergency theatres running in parallel as an attempt to minimise these effects.We aimed to assess the change in delivery of essential and emergency surgeries due to the pandemic in a local district general hospital.MethodsRetrospective study of emergency theatre cases performed during the month of November 2019 and November 2020. Parameters of theatre efficiency included: sending times, anaesthetic times, operating times and length of recovery, with specific attention to recovery in theatre timeResultsThe time taken to send for patients from the wards increased by 24% (n = 124 vs 49) during the pandemic compared with before. Anaesthetic time also increased by 15% (p = 0.0072, n = 124 vs 49). Recovery time required in theatre increased by 150% (p = 0.0321, n = 124 vs 49). Total recovery time however reduced by 9%.ConclusionOur audit quantifies the effects of COVID 19 pandemic on surgical care delivery and documents delays at nearly all stages of the patient journey through emergency theatres.Alternating procedures in a second emergency theatre has mitigated the delay of theatre-based recovery.

EP.FRI.271 The impact of Surgical Assessment Unit on emergency and ambulatory surgical care in a district general hospital

Abstract Aims There has been a paradigm shift in the delivery of emergency and ambulatory surgical care necessitated by paucity of beds, improved expedited diagnostics and delayed transit in Emergency departments. The objective of a surgical assessment unit (SAU) is to reduce the number of semi-urgent admissions, provide direct access to urgent surgical admissions bypassing the ED, expeditious assessment by senior clinicians and to reduce the number of OPD follow up. In our setting, the SAU came into existence on all 5 working days at 12-hour daily schedule and its impact was evaluated retrospectively. Methods Prospectively maintained data base over a 2-month period was examined. Pre and post SAU figures were compared to judge any quantitative improvement in surgical services. Results During the audit period of 2 months there were 156 emergency patients and 190 ward attenders for follow up care. Majority of these patients were assessed within 4 hours and discharged or ambulated. Numbers being admitted overnight purely to facilitate investigations showed a decrease of 44.6% post SAU establishment. There was a reduction in post discharge outpatients appointments when compared to a similar time period pre SAU (14% difference). Conclusion The SAU, although initially conceived and designed purely to cope with increased admissions and to minimise breaching of emergency department targets, has shown quantitative and qualitative improvement in emergency and ambulatory surgical care delivery.

The ophthalmic surgical backlog associated with the COVID-19 pandemic: a population-based and microsimulation modelling study.

Background:Jurisdictions worldwide ramped down ophthalmic surgeries to mitigate the effects of COVID-19, creating a global surgical backlog. We sought to predict the long-term impact of COVID-19 on the timely delivery of non-emergent ophthalmology sub-specialty surgical care in Ontario.Methods:This is a microsimulation modelling study. We used provincial population-based administrative data from the Wait Time Information System database in Ontario for January 2019 to May 2021 and facility-level data for March 2018 to May 2021 to estimate the backlog size and wait times associated with the COVID-19 pandemic. For the postpandemic recovery phase, we estimated the resources required to clear the backlog of patients accumulated on the wait-list during the pandemic. Outcomes were accrued over a time horizon of 3 years.Results:A total of 56 923 patients were on the wait-list in the province of Ontario awaiting non-emergency ophthalmic surgery as of Mar. 15, 2020. The number of non-emergency surgeries performed in the province decreased by 97% in May 2020 and by 80% in May 2021 compared with the same months in 2019. By 2 years and 3 years since the start of the pandemic, the overall estimated number of patients awaiting surgery grew by 129% and 150%, respectively. The estimated mean wait time for patients for all subspecialty surgeries increased to 282 (standard deviation [SD] 91) days in March 2023 compared with 94 (SD 97) days in 2019. The provincial monthly additional resources required to clear the backlog by March 2023 was estimated to be a 34% escalation from the prepandemic volumes (4626 additional surgeries).Interpretation:The estimates from this microsimulation modelling study suggest that the magnitude of the ophthalmic surgical backlog from the COVID-19 pandemic has important implications for the recovery phase. This model can be adapted to other jurisdictions to assist with recovery planning for vision-saving surgeries.

Surgery, anesthesia, and pathology: A practical primer on greening the delivery of surgical care

Because of its energy intensive requirements and multi-disciplinary interdependencies, perioperative care, including surgery, anesthesia, and pathology, is one of the greatest contributors to the direct greenhouse gas emissions of healthcare systems. By reducing this contribution, the paradox of harming human health through the delivery of healthcare services can be addressed. Energy use and waste generation are the main underlying factors contributing to these downstream health harms of providing surgical care. On-site energy is consumed primarily by heating ventilation and air conditioning systems, lighting, and equipment. A variety of different types of waste are also generated on-site, including regulated medical waste, healthcare plastic and packaging waste, single-use devices, anesthetic gasses, medication, chemicals, and water. In this review, we discuss practical ways to reduce direct energy use and decrease and avoid waste generation during the surgical experience. Following these environmental best practices supports triple bottom line performance, which delivers significant financial, environmental, and social benefits.

Perceptions of Mobile Health Technology in Elective Surgery: A Qualitative Study of North American Surgeons.

To explore the surgeon-perceived added value of mobile health technologies (mHealth), and determine facilitators of and barriers to implementing mHealth. Despite the growing popularity of mHealth and evidence of meaningful use of patient-generated health data in surgery, implementation remains limited. This was an exploratory qualitative study following the Consolidated Criteria for Reporting Qualitative Research. Purposive sampling was used to identify surgeons across the United States and Canada. The Consolidated Framework for Implementation Research informed development of a semistructured interview guide. Video-based interviews were conducted (September-November 2020) and interview transcripts were thematically analyzed. Thirty surgeons from 8 specialties and 6 North American regions were interviewed. Surgeons identified opportunities to integrate mHealth data pre- operatively (eg, expectation-setting, decision-making) and during recovery (eg, remote monitoring, earlier detection of adverse events) among higher risk patients. Perceived advantages of mHealth data compared with surgical and patient-reported outcomes included easier data collection, higher interpretability and objectivity of mHealth data, and the potential to develop more patientcentered and functional measures of health. Surgeons identified a variety of implementation facilitators and barriers around surgeon- and patient buy-in, integration with electronic medical records, regulatory/reimbursement concerns, and personnel responsible for mHealth data. Surgeons described similar considerations regarding perceptions of mHealth among patients, including the potential to address or worsen existing disparities in surgical care. These findings have the potential to inform the effective and equitable implementation of mHealth for the purposes of supporting patients and surgical care teams throughout the delivery of surgical care.

PD14-08 THE IMPACT OF COVID-19 ON SURGICAL CARE DELIVERY FOR PATIENTS WITH URINARY STONES

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation I (PD14)1 Sep 2021PD14-08 THE IMPACT OF COVID-19 ON SURGICAL CARE DELIVERY FOR PATIENTS WITH URINARY STONES John Michael DiBianco, Stephanie Daignault-Newton, John Ludlow, Jessica Phelps, Erik Ratchford, Michael Cotant, Khurshid R. Ghani, Casey A. Dauw, and for the Michigan Urological Surgery Improvement Collaborative John Michael DiBiancoJohn Michael DiBianco More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , John LudlowJohn Ludlow More articles by this author , Jessica PhelpsJessica Phelps More articles by this author , Erik RatchfordErik Ratchford More articles by this author , Michael CotantMichael Cotant More articles by this author , Khurshid R. GhaniKhurshid R. Ghani More articles by this author , Casey A. DauwCasey A. Dauw More articles by this author , and for the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001990.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: During the COVID-19 pandemic, limits on elective surgical care were instituted by hospitals to preserve resources. Additionally, patients’ desire to limit health care contact may impact surgical decision making. We aimed to understand how institutional pressures and patient preference affected the delivery, choice and outcome of ambulatory surgical care for urinary stone disease during the COVID-19 pandemic. METHODS: Reducing Operative Complications from Kidney Stones (ROCKS) is a quality improvement initiative from the Michigan Urological Surgery Improvement Collaborative (MUSIC) that maintains a prospective clinical registry of ureteroscopy (URS) and shockwave lithotripsy (SWL) cases. Using this registry, we categorized all cases by time frame, defining July 1st - December 31st 2019 as preCOVID (PC), March 16th - June 15th 2020 as duringCOVID (DC) and June 16th - September 15th 2020 as afterCOVID (AC). Patients in each cohort were characterized across a range of sociodemographic and clinical factors. We assessed changes in procedure choice (URS vs SWL), procedure acuity (elective vs emergent), and outcomes (ED visit and hospitalization within 30 days of surgery). RESULTS: 6375 cases were identified, 4513 URS and 1862 SWL. PC consisted of 3310 cases (2238 URS and 1072 SWL), DC consisted of 1141 cases (888 URS and 253 SWL) and AC consisted of 1924 cases (1387 URS and 537 SWL). A higher proportion of URS cases were performed DC compared to PC and AC (77.8% vs 67.6% vs 72.1%, p <0.001, respectively). A higher percentage of emergent cases in DC compared to PC and AC (21.8% vs 13.7% vs 15.3%, p <0.001, respectively). Significantly more cases in DC compared to PC and AC were prestented, had positive UA/urine culture, ureteral stones, had hydronephrosis, were stented and had longer stent dwell time. ED visits and unplanned hospitalizations were not significantly different. CONCLUSIONS: The COVID-19 pandemic resulted in a lower overall stone treatment rates and higher proportions of URS compared to SWL. Significantly more emergent cases for ureteral stones with positive UA/urine cultures and evidence of obstruction were performed duringCOVID with higher stent placement rates and longer stent dwell times. These data pointing towards preference for higher intensity or acuity cases without differences in unplanned healthcare encounters. Source of Funding: Funding from Blue Cross Blue Shield of Michigan © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e218-e219 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Michael DiBianco More articles by this author Stephanie Daignault-Newton More articles by this author John Ludlow More articles by this author Jessica Phelps More articles by this author Erik Ratchford More articles by this author Michael Cotant More articles by this author Khurshid R. Ghani More articles by this author Casey A. Dauw More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

Initial Assessment of the Effect of ProvenCare on Lung Cancer Surgical Quality

BackgroundProvenCare is a joint initiative of the American College of Surgeons Commission on Cancer, Geisinger, and The Society of Thoracic Surgeons (STS) to standardize evidence-based practices in the delivery of surgical lung cancer care. This study compares outcomes of ProvenCare patients with the STS Database. MethodsBest practice elements were agreed on through expert consensus meetings. ProvenCare elements were used to direct care. Compliance was monitored while clinical outcomes were collected within the STS General Thoracic Surgery Database (GTSD). ProvenCare patient outcomes were compared with outcomes in all other STS GTSD patients. Univariable and multivariable logistic regression models compared morbidity and mortality. ResultsA total of 2026 patients at 23 ProvenCare hospitals were compared with 71 565 control patients at 311 hospitals from 2010 to 2016. ProvenCare patients were more likely to receive guideline-recommended staging evaluations and more likely to have mediastinal staging performed during resection (63.4% vs 49.4%; P < .001). There was no difference in 30-day mortality (1.4% vs 1.3% lobectomy [P = .84]; 3.4% vs 2.0% all other resections [P = .054]) or STS indicator complications (10.8% vs 9.9% lobectomy [P = .21]; 9.2% vs 9.4% all other resections [P = .92]). When controlling for patient-level clinical and demographic risk factors, the likelihood of perioperative morbidity and mortality was not significantly different (odds ratio [OR], 1.07 [95% CI, 0.77-1.47] lobectomy; OR, 0.97 [95% CI, 0.62-1.50] all other resections). ConclusionsVariability in preoperative evaluation of patients with lung cancer represents an opportunity to improve quality of care. ProvenCare increased use of guideline-recommended preoperative processes, which may improve cancer outcomes and survival, without resulting in differences in short-term surgical outcomes.

Impact of COVID-19 Pandemic on a Tertiary Care Center's Surgical Volume and Outcomes: a Single Institutional Study from Northeast India.

In this study, we aimed to compare the surgical volume and outcomes between this COVID-19 period and data from non-COVID-19 period of last year. A retrospective observational study was done in one single surgical unit of a dedicated oncology center in a peripheral location in India. The comparison was done between patients undergoing major cancer surgery during the COVID-19 pandemic period of 1st April to 30th June 2020, when a nation-wide lockdown was in force, to a comparable period of last year. Statistical analysis was done using SPSS software 20.0. A total of 72 patients underwent major cancer surgery during this period, with surgery for breast cancer (n = 26) being the major sub-site operated. This was a significant decrease from the total 209 major cancer surgeries performed during a similar period of last year (2019) (p < 0.05). There were several reasons for the decrease in surgical numbers, including the difficulty in travel and accommodation during the lockdown period. The mean distance of patient’s residence from the treating hospital was 45.7 km (range 4 to 165 km). Public transport was in a limbo and inter-state travel was restrictive with mandatory quarantine rules in effect. Morbidity associated with major surgeries was observed to be significantly less during the COVID-19 period compared to the pre-COVID-19 times (8.3% vs 17.2% with a p value of < 0.05), which can probably be attributed to the lesser number of complex surgical procedures being performed. There was no significant difference between the total mortality percentages (2.8% vs 3.8%). A total of 156 PPE kits were used (3–4/per patient) throughout the in-hospital care of the surgical patients included in this study. In the midst of a pandemic, the delivery of surgical cancer care is an essential service and although the surgical volume is significantly hampered due to various reasons, the outcomes are largely unaffected.

Non-Governmental Organizations Delivering Global Cardiac Surgical Care: A Quantitative Impact Assessment

In low- and middle-income countries (LMICs), 93% of the population lacks safe, timely, and affordable access to cardiac surgical care when needed. As countries slowly build or expand local, independent cardiac centers, non-governmental organizations (NGOs) partially bridge the gap in cardiac surgical care delivery in LMICs. However, little is known about the current scope of cardiac NGOs. Here, we perform an analysis of active NGOs involved with the delivery of cardiac surgical services in LMICs or for patients from LMICs. Cardiac surgery NGOs were identified from medical literature, established NGO databases, and Google Scholar searches. The search was performed between December 2019 and May 2020. NGOs whose websites were not updated or described missions or projects taking place no later than 2015 were considered inactive. Eighty-six NGOs are actively providing cardiac surgery services in LMICs or treating patients from LMICs. Five NGOs performed adult cardiac surgery only, 56 performed pediatric cardiac surgery only, and 25 performed both adult and pediatric cardiac surgery. NGOs originated from 23 different countries and were operational in a total of 111 countries, 96 of them being LMICs. Fifty-three NGOs reported data on annual surgical volume, of which half performed less than 50 operations per year. NGOs effectively address the burden of cardiac surgical disease in LMICs and contribute to local capacity-building. Increased, more detailed, and standardized reporting of the impact and outcomes of NGOs is necessary to better understand annual cardiac surgical volume and to support local centers working towards independent services.

Safe Delivery of Surgical Care in Head and Neck Cancer Patients During COVID-19-an Audit of Pattern of Presentation and Treatment Strategies in an Oncology Centre in the Northern India.

Delay in treatment of head and neck cancer leads to stage migration and increased morbidity. Due to the COVID-19, surgical care has been severely affected. We continued our oncology services during the pandemic. We present here the pattern of presentation of head and neck cancer patients to the hospital and strategy to continue services. A retrospective audit of patients registered under Head and Neck Disease Management Group during lockdown, 23rd March to 31st May 2020, was done. Four categories were made new registrations, post-surgical patients, emergency department visits and follow-up presentation. Of the 693 patients assessed, a majority were with oral cavity cancer (80%). Seventy-eight percent of patients presented with stage IV disease. There were 382 new registrations, of which 68% were symptomatic. Of the 69 patients that underwent surgery, 17 patients were on adjuvant treatment. A total of 60 patients presented to emergency department during this period, maximum with complaints of dyspnoea (67%). One hundred eighty-nine patients were follow-up patients of which 43% were symptomatic. Among these, 12 patients were diagnosed with recurrence. Various administrative and clinical policies were formulated to continue cancer care during this time. Surgical services need not be halted during the COVID-19 pandemic. Following scientific rationale and treatment strategies, safe oncosurgical care can be delivered during pandemic.

The Evolving Landscape of Global Surgery: A Qualitative Study of North American Surgeons' Perspectives on Faith-Based and Academic Initiatives.

Faith-based missions have played a large role in surgical care delivery in low- and middle-income countries (LMIC). As global surgery is now an academic discipline, this pilotstudy sought to understand how different faith ideologies influence surgeon motivations and subsequent culture of the global surgery landscape. Interviews were conducted with North American surgeons who pursue global surgery significantly in their career. Points of discussion included early influences, obstacles, motivations, philosophy and approach to global surgery work, and experiences with faith-based (FBO) and non-faith-based organizations (NFBO). Notes were transcribed and thematic analysis performed. Sixteen surgeons were interviewed (11 men, 5 women, ages 39-75years-old). Surgeons had worked in 32 countries with FBO and NFBO in intermittent or long-term capacity. Religious upbringing and current affiliations included Atheism, Protestant Christianity, Catholicism, Hinduism, Judaism, Mormonism, Islam, and nonreligious spirituality. Early influences included international upbringing (n = 7), emphasis on service (n = 9), and exposure to the religious mission concept (n = 6). The most common core motivation among all participants was addressing disparities (n = 10). Some believed that FBO and NFBO have different goals (n = 4), and only surgeons identifying with Christianity believed the goals are similar (n = 3). Participants expressed that FBO are exclusive (n = 4) and focused on proselytization (n = 6) while NFBO are humanitarian (n = 3) but less integrated into the community (n = 4). Global surgeons have shared early influences, obstacles, and desire to address disparities. Perceptions of FBO and NFBO differed based on religious background. This pilot study will inform future studies regarding the collaborations of FBO and NFBO to improve global surgical care.

Understanding the motivation of nurses volunteering for non-disaster humanitarian service

BackgroundNurses who volunteer in a nondisaster humanitarian surgical mission receive little attention in the research literature. PurposeThe purpose of this study was to explore how nurses involved in short-term nondisaster humanitarian care perceived and managed their experiences of working in a volunteer nursing capacity in a low- to middle-income country. MethodAn immersive ethnographic method was used. Participants comprised 150 international registered nurses from 12 countries. Data collection incorporated 49 semistructured interviews and reflections on 1,500 hours of participant observation. Data were analysed using a thematic, inductive approach, following the consolidated criteria for reporting qualitative research guidelines. ResultsThe results of this qualitative enquiry revealed essential aspects of the nursing culture within a specific humanitarian nursing context—that is, promoting social justice and addressing health disparity through the delivery of compassionate surgical care. This paper presents data describing nurses’ motivations for participating as volunteers in humanitarian work. DiscussionNurses are more likely to offer increased effort and enthusiasm when there is congruency between their beliefs, their professional identity, and their ability to enact on these. Understanding humanitarian nurses’ motivations gives guidance to leaders involved in managing, attracting, and retaining suitable nursing staff and orienting, debriefing, and supporting re-entry after withdrawing from short-term medical assignments that share a common imperative to care for the underserved.

Clinicians' perceptions around discectomy surgery for lumbar disc herniation: a survey of orthopaedic and neuro-surgeons in Australia and New Zealand.

Understanding practice-based differences in treatment of lumbar disc herniations (LDHs) is vital for reducing unwarranted variation in the delivery of spine surgical health care. Identifying factors that influence surgeons' decision-making will offer useful insights for developing the most cost-effective and safest surgical strategy as well as developing surgeon education materials for common lumbar pathologies. This study was to capture any variation in techniques used by surgeons in Australia and New Zealand (ANZ) region, and perceived complications of different surgical procedures for primary and recurrent LDH (rLDH). Web-based survey study was emailed to orthopaedic and neurosurgeons who routinely performed spinal surgery in ANZ from Decmber 20, 2018 to February 20, 2020. The response data were analyzed to assess for differences based on geography, practice setting, speciality, practice experience, practice length, and operative volume. Invitations were sent to 150 surgeons; 96 (64%) responded. Most surgeons reported microdiscectomy as their surgical technique of choice for primary LDH (73%) and the first rLDH (72%). For the second rLDH, the preferred choice for most surgeons was fusion surgery (82%). A surgeon's practice setting (academic/private/hybrid) was a statistically significant factor in what surgical procedure was chosen for the first rLDH (P = 0.014). When stratifying based on surgeon experience, there were statisfically significant differences based on the annual volume of spine surgeries performed (perceived reherniation rates following primary discectomy, P = 0.013; perceived reherniation rates following revision surgeries, P = 0.017; perceived intraoperative complications rates following revision surgeries, P = 0.016) and based on the annual volume of lumbar discectomies performed (perceived reherniation rates following revision surgeries, P = 0.022; perceived intraoperative complications rates following revision surgeries, P = 0.036; perceived durotomy rates following primary discectomy, P = 0.023). Surgeons' annual practice volume and practice setting have significant influences in the selection of surgical procedures and the perception of surgical complications when treating LDHs.