Cancellation Of Elective Surgery Research Articles

Healthcare system impacts of the 2017 Manchester Arena bombing: evidence from a national trauma registry patient case series and hospital performance data

IntroductionIn response to detonation of an improvised explosive device at the Manchester Arena on 22 May 2017, we aimed to use detailed information about injured patients flowing through hospital healthcare...

Balancing scarce hospital resources during the COVID-19 pandemic using discrete-event simulation

COVID-19 has disrupted healthcare operations and resulted in large-scale cancellations of elective surgery. Hospitals throughout the world made life-altering resource allocation decisions and prioritised the care of COVID-19 patients. Without effective models to evaluate resource allocation strategies encompassing COVID-19 and non-COVID-19 care, hospitals face the risk of making sub-optimal local resource allocation decisions. A discrete-event-simulation model is proposed in this paper to describe COVID-19, elective surgery, and emergency surgery patient flows. COVID-19-specific patient flows and a surgical patient flow network were constructed based on data of 475 COVID-19 patients and 28,831 non-COVID-19 patients in Addenbrooke’s hospital in the UK. The model enabled the evaluation of three resource allocation strategies, for two COVID-19 wave scenarios: proactive cancellation of elective surgery, reactive cancellation of elective surgery, and ring-fencing operating theatre capacity. The results suggest that a ring-fencing strategy outperforms the other strategies, regardless of the COVID-19 scenario, in terms of total direct deaths and the number of surgeries performed. However, this does come at the cost of 50% more critical care rejections. In terms of aggregate hospital performance, a reactive cancellation strategy prioritising COVID-19 is no longer favourable if more than 7.3% of elective surgeries can be considered life-saving. Additionally, the model demonstrates the impact of timely hospital preparation and staff availability, on the ability to treat patients during a pandemic. The model can aid hospitals worldwide during pandemics and disasters, to evaluate their resource allocation strategies and identify the effect of redefining the prioritisation of patients.

Cancellation of elective surgery: rates, reasons and effect on patient satisfaction.

BackgroundThe cancellation of elective surgeries is a major problem that increases wait times, exacerbates costs and can negatively affect patients, both psychologically and physically. Our objectives were to investigate the reasons for cancellations across specialties at a single centre, to compare these reasons with previous data from the same centre between 2005 and 2009 and to examine how cancellations affected patients’ lives and views of the medical system in cases when the cancellations were potentially preventable.MethodsCancellation records of all elective surgeries scheduled between June 1, 2012, and Jan. 31, 2016, at a medium-sized, tertiary care, academic centre were retrospectively reviewed. We evaluated the rates and reasons for cancellation and interviewed a subset of patients whose surgery was cancelled for a potentially preventable reason (i.e., operating room running late, bed shortage, emergency case took place of scheduled surgery).ResultsAcross 11 surgical specialties, 2933 of 20 881 surgeries (14.0%) were cancelled and of these, 2448 (83.5%) were for administrative or structural reasons. Compared with the data collected previously for general, gynecological and urological procedures, cancellation rates increased from 8.1% to 11.8%. Although patients reported inconvenience, they were generally satisfied with the availability and the quality of the health care they received.ConclusionConsistent with the previous study, our data suggest that most cancellations occur because of administrative or structural processes that are potentially preventable. Targeting these processes may help to reduce cancellations for elective surgeries and thereby improve economic efficiency and patient outcomes.

Cancelamento cirúrgico: percepção de enfermeiros do bloco operatório

Objetivo: Identificar a percepção de enfermeiros do bloco operatório sobre os motivos para o cancelamento de cirurgias eletivas e as estratégias parareduzir as taxas de suspensão. Método: Estudo de abordagem qualitativa realizado em um hospital de alta complexidade do Recife, Pernambuco, Brasil, com enfermeirosatuantes no bloco operatório. A coleta de dados foi realizada por meio de entrevistas gravadas com sete enfermeiros responsáveis pelas cirurgias eletivas.Para o tratamento dos dados, utilizou-se a técnica da análise de conteúdo de Bardin. Resultados: Os discursos foram agrupados em duas categorias temáticas:lacunas no planejamento cirúrgico, com três subcategorias, e prevenção de situações evitáveis, com duas subcategorias. Conclusão: Os motivos para o cancelamentode cirurgias estavam relacionados ao planejamento do ambiente cirúrgico e à preparação clínica do paciente. Os enfermeiros identificaram esses motivoscomo situações evitáveis e consideraram que a comunicação efetiva e atitudes de liderança assertivas são estratégias que reduzem os índices de suspensão cirúrgica.

Urology Amidst the War on COVID-19

Objectives: We sought to review the impact of the COVID-19 pandemic on the practice of urology internationally, with particular focus on the Australian response. Methods: A literature search of PubMed was conducted using search terms “urology,” “coronavirus,” “COVID-19,”and “surgery.” This generated 165 articles. The abstracts were reviewed for relevance, and 33 articles were selected, reviewed in depth, and information synthesised along with relevant government, surgical college, and urological society policy documents. Results: Extensive health care changes have been implemented worldwide to curb infection rates. Elective surgery cancellations have been widely mandated to curb infection rates with mixed success. Whilst demand on hospital resources was reduced by up to 80%, the estimated cost to clear the surgical backlog in the UK has reached £100 million. Strict perioperative precautions have also been employed with mandatory personal protective equipment for all surgical staff and guidelines fast tracked for safe aerosol-generating procedures. Attempts to reduce exposure to patients and health care workers resulted in compromised operative time, blood loss, and length of hospital stay, with potential increased risk of short- and long-term complications. Systemic changes to education and training have also been made. Clinically, the cancellation of training examinations and a freeze on rotations and elective surgery restrictions have blunted surgical experience and teaching. The effect has rippled through junior doctor positions, with uncertainty remaining for training positions in 2021. Conclusions: The COVID-19 pandemic is the greatest current challenge facing health care worldwide. Amidst elective surgery restrictions, novel preoperative testing procedures and intraoperative precautions, providing safe and appropriate urological care is a major challenge. This review was derived entirely from expert opinion articles. Further research into the virus is needed to bring the world safely through the pandemic, and post-pandemic recovery will likely be the next challenge.

COVID-19-related cancellation of elective orthopaedic surgery caused increased pain and psychosocial distress levels

PurposeHealth care systems in most European countries were temporarily restructured to provide as much capacity as possible for the treatment of coronavirus disease 2019 (COVID-19) patients. Subsequently, all elective surgeries had to be cancelled and postponed for months. The aim of the present study was to assess the pretreatment health status before and after COVID-19-related cancellation and the psychosocial distress caused by the cancellation.MethodsFor this study, a questionnaire was developed collecting sociodemographic data and information on health status before and after the cancellation. To assess psychosocial distress, the validated depression module of the Patient Health Questionnaire (PHQ-9), was implemented. PHQ-9-Scores of 10 and above were considered to indicate moderate or severe depressive symptoms. In total, 119 patients whose elective orthopaedic surgery was postponed due to the COVID-19 pandemic were surveyed once at least 8 weeks after the cancellation.ResultsSeventy-seven patients (65%; 34 female, 43 male) completed the questionnaire and were included. The predominant procedures were total knee arthroplasty (TKA), hip arthroscopy and foot and ankle surgery. The mean pain level significantly increased from 5.5 ± 2.2 at the time of the initially scheduled surgery to 6.2 ± 2.5 at the time of the survey (p < 0.0001). The pain level before cancellation of the surgery was significantly higher in female patients (p = 0.029). An increased analgetic consumption was identified in 46% of all patients. A mean PHQ-9 score of 6.1 ± 4.9 was found after cancellation. PHQ-9 scores of 10 or above were found in 14% of patients, and 8% exhibited scores of 15 points or above. Significantly higher PHQ-9 scores were seen in female patients (p = 0.046). No significant differences in PHQ-9 scores were found among age groups, procedures or reasons for cancellation.ConclusionCancellation of elective orthopaedic surgery resulted in pain levels that were significantly higher than when the surgery was scheduled, leading to increased analgesic use. Additionally, significant psychosocial distress due to the cancellation was identified in some patients, particularly middle-aged women. Despite these results, confidence in the national health care system and in the treating orthopaedic surgeons was not affected.Level of evidenceLevel III.

Experiences of a \u201cCOVID protected\u201d robotic surgical centre for colorectal and urological cancer in the COVID-19 pandemic

The recent COVID-19 pandemic led to the cancellation of elective surgery across the United Kingdom. Re-establishing elective surgery in a manner that ensures patient and staff safety has been a priority. We report our experience and patient outcomes from setting up a “COVID protected” robotic unit for colorectal and renal surgery that housed both the da Vinci Si (Intuitive, Sunnyvale, CA, USA) and the Versius (CMR Surgical, Cambridge, UK) robotic systems. “COVID protected” robotic surgery was undertaken in a day-surgical unit attached to the main hospital. A standard operating procedure was developed in collaboration with the trust COVID-19 leadership team and adapted to national recommendations. 60 patients underwent elective robotic surgery in the initial 10-weeks of the study. This included 10 colorectal procedures and 50 urology procedures. Median length of stay was 4 days for rectal cancer procedures, 2 days less than prior to the COVID period, and 1 day for renal procedures. There were no instances of in-patient coronavirus transmission. Six rectal cancer patients waited more than 62 days for their surgery because of the initial COVID peak but none had an increase T-stage between pre-operative staging and post-operative histology. Robotic surgery can be undertaken in “COVID protected” units within acute hospitals in a safe way that mitigates the increased risk of undergoing major surgery in the current pandemic. Some benefits were seen such as reduced length of stay for colorectal patients that may be associated with having a dedicated unit for elective robotic surgical services.

Recommendation for Resuming Elective Surgery during the Normalising Period in COVID-19 Pandemic.

Recommendation for Resuming Elective Surgery during the Normalising Period in COVID-19 Pandemic.

A Curriculum for Perioperative Nurse Deployment During a Pandemic

ABSTRACTAs the coronavirus disease 2019 (COVID‐19) pandemic spread around the world, the US Surgeon General called for the cancellation of elective surgeries. At a large academic medical center in the Northeast, there was a resulting surplus of perioperative nurses who were deployed to inpatient units in need of skilled nursing care for a surge of COVID‐19 patients. To prepare them for deployment to inpatient units, perioperative leaders developed a core curriculum to ensure that the OR nurses possessed the skills and knowledge required to successfully care for patients outside the OR with the same level of care and compassion that they provided to perioperative patients. The leaders employed available resources at the hospital to design and implement the course in a short amount of time. This article describes the development of a curriculum for OR nurses to manage a surging patient volume on inpatient units because of the COVID‐19 pandemic.

The Cost of Quarantine: Projecting the Financial Impact of Canceled Elective Surgery on the Nation's Hospitals.

We sought to quantify the financial impact of elective surgery cancellations in the US during COVID-19 and simulate hospitals' recovery times from a single period of surgery cessation. COVID-19 in the US resulted in cessation of elective surgery-a substantial driver of hospital revenue-and placed patients at risk and hospitals under financial stress. We sought to quantify the financial impact of elective surgery cancellations during the pandemic and simulate hospitals' recovery times. Elective surgical cases were abstracted from the Nationwide Inpatient Sample (2016-2017). Time series were utilized to forecast March-May 2020 revenues and demand. Sensitivity analyses were conducted to calculate the time to clear backlog cases and match expected ongoing demand in the post-COVID period. Subset analyses were performed by hospital region and teaching status. National revenue loss due to major elective surgery cessation was estimated to be $22.3 billion (B). Recovery to market equilibrium was conserved across strata and influenced by pre- and post-COVID capacity utilization. Median recovery time was 12-22 months across all strata. Lower pre-COVID utilization was associated with fewer months to recovery. Strategies to mitigate the predicted revenue loss of $22.3B due to major elective surgery cessation will vary with hospital-specific supply-demand equilibrium. If patient demand is slow to return, hospitals should focus on marketing of services; if hospital capacity is constrained, efficient capacity expansion may be beneficial. Finally, rural and urban nonteaching hospitals may face increased financial risk which may exacerbate care disparities.

Prevalence and factors associated with cancellation and deferment of elective surgical cases at a rural private tertiary hospital in Western Uganda: a cross sectional study

Introductionthe cancellation of elective surgery is still a worldwide challenge and this is associated with emotional and economical trauma for the patients and their families as well as a decrease in the efficiency of the operating theatre. This study aimed at determining the prevalence and factors associated with cancellation and deferment of elective surgery in a rural private tertiary teaching hospital in Western Uganda.Methodsa cross-sectional study design was conducted. Data was collected from 1st July 2019 to 31st December 2019. Patients scheduled for elective surgery and either cancelled or deferred on the actual day of surgery were included in the study. Statistical analysis was done using STATA version 15.Resultsfour hundred patients were scheduled for elective surgery during the study period, among which 90 (22.5%) were cancelled and 310 (78.5%) had their surgeries as scheduled. The highest cancellation of elective surgical operations was observed in general surgery department with 81% elective cases cancelled or deferred, followed by orthopedic department 10% and gynecology department 9%. The most common reasons for cancellation were patient-related (39%) and health worker-related (35%) factors. Other factors included administrative (17%) and anesthesia related factors (9%). Cancellation was mainly due to lack of finances which accounted for 23.3% of the patients, inadequate patient preparation (16.6%) and unavailability of surgeons (15.5%). Major elective surgeries were cancelled 1.7 times more than minor electives surgeries [adjusted prevalence ratio 1.7 (95%CI: 1.07-2.73) and p-value: 0.024].Conclusioncancellation and deferment of elective surgeries is still of a major concern in this private rural tertiary hospital with most of the reasons easily preventable through proper scheduling of patients, improved communication between surgical teams and with patients; and effective utilization of available resources and man power.

Hysteroscopy in COVID-19 times

Objective: The coronavirus disease 2019 (COVID-19) pandemic is a global public health concern. Health Care Facilities in every country have to deal with a complete reorganization of labor and delivery unit, and resource management. Aim of this review is to summarize the available literature data about the impact of COVID-19 on hysteroscopic surgery. Mechanism: A search on PubMed and Medline databases was performed until March 2021. Findings in brief: Most of evidence agree on complete cancellation of elective endoscopic gynecologic surgery, and on its deferring until the pandemic has been contained. When hysteroscopy is performed, precautions should be observed to prevent COVID-19 infection. Conclusions: We summarized all best practice to perform safe and effective hysteroscopic surgery in COVID-19 times and in the slow restore of normal activities.

Why is Elective Ophthalmic Surgery Cancelled? A Retrospective Evaluation

Making efficient use of operating rooms (OR) is an important issue so decreasing the cancellation rate of surgery is one method that could increase efficiency. This study was done to report potentially preventable causes of elective ophthalmic surgery cancellations and we reviewed all OR cancellations in 2017 to survey the cancellation causes.

Collateral damage of the COVID-19 pandemic: an alarming decline in critical procedures in otorhinolaryngology in a German university hospital

PurposeThe COVID-19 pandemic has a major impact on the diagnosis and treatment of ENT patients. The aim of this study was to analyze the influence of the pandemic on the number of otolaryngological procedures, particularly for critical diagnoses with potential negative effects due to prolonged symptom duration.MethodsWe evaluated 10,716 surgical procedures between January 1, 2018 and May 31, 2020, focusing on the 16-week period around March 16, 2020, which includes 1080 observations. We further analyzed subsets of critical procedures.ResultsWe found a decline in critical procedures by 43% although no critical procedures were postponed by the hospital. Meanwhile, the share of critical procedures increased up to 90% caused by the cancellation of elective surgery. Especially worrisome was that diagnostic procedures for suspected malignancies decreased by 41% during the pandemic.ConclusionThe decline in critical procedures in otorhinolaryngology as collateral damage of the COVID-19 pandemic is considerable and therefore alarming.

The London Major Trauma Network System: A Literature Review.

Trauma is one of the leading causes of death and disability worldwide and is a major global public health problem. The provision of trauma care has been substandard in England and Wales prior to the implementation of an inclusive major trauma network system in London in 2010 and subsequently across the rest of England two years later. The implementation of the London trauma system has brought about improvements to the delivery of trauma care by decreasing the overall morbidity and mortality significantly. This framework encompasses the collaboration of emergency services, designated Major Trauma Centres (MTCs), Trauma Units (TUs) and community providers which have been optimized with the expertise and resources to provide the best outcomes for major trauma patients. Specific triage protocols, consultant-led trauma service and on-the-spot access to radiology services and operating theatres have played a pivotal role in the improvement of trauma care. In spite of several strengths, however, the London major trauma network system is by no means without its limitations. The emergence of the new coronavirus disease 2019 (COVID-19) pandemic has created major barriers to the smooth running of trauma services by exhausting resources due to infection control measures, reduced theatre space and re-deployment of medical staffs. In addition, the cancellation of elective surgeries has impacted directly on the training of surgical trainees by leaving them with significantly reduced surgical exposure. As a results of this ever changing surgical landscape, a need to urgently review these traditional surgical training methods with a view to modernize the curriculum. Although the London trauma system has evolved significantly since its implementation, its limitations should be recognized and addressed to enhance performance and improve patient outcomes.

Neurosurgery in times of a pandemic: a survey of neurosurgical services during the COVID-19 outbreak in the Veneto region in Italy

The purpose of this study was to analyze the effect of the coronavirus disease 2019 (COVID-19) outbreak and of the subsequent lockdown on the neurosurgical services of the Veneto region in Italy compared to the previous 4 years. A survey was conducted in all 6 neurosurgical departments in the Veneto region to collect data about surgical, inpatient care and endovascular procedures during the month of March for each year from 2016 to 2020. Safety measures to avoid infection from SARS-CoV-2 and any COVID-19 cases reported among neurosurgical patients or staff members were considered. The mean number of neurosurgical admissions for the month of March over the 2016-2019 period was 663, whereas in March 2020 admissions decreased by 42%. Emergency admissions decreased by 23%. The average number of neurosurgical procedures was 697, and declined by 30% (range -10% to -51% in individual centers). Emergency procedures decreased in the same period by 23%. Subarachnoid hemorrhage and spontaneous intracerebral hemorrhage both decreased in Veneto-by 25% and 22%, respectively. Coiling for unruptured aneurysm, coiling for ruptured aneurysm, and surgery for ruptured aneurysm or arteriovenous malformation diminished by 49%, 27%, and 78%, respectively. Endovascular procedures for acute ischemic stroke (AIS) increased by 33% in 2020 (28 procedures in total). There was a slight decrease (8%) in brain tumor surgeries. Neurosurgical admissions decreased by 25% and 35% for head trauma and spinal trauma, respectively, while surgical procedures for head trauma diminished by 19% and procedures for spinal trauma declined by 26%. Admissions and surgical treatments for degenerative spine were halved. Eleven healthcare workers and 8 patients were infected in the acute phase of the pandemic. This multicenter study describes the effects of a COVID-19 outbreak on neurosurgical activities in a vast region in Italy. Remodulation of neurosurgical activities has resulted in a significant reduction of elective and emergency surgeries compared to previous years. Most likely this is a combined result of cancellation of elective and postponable surgeries, increase of conservative management, increase in social restrictions, and in patients' fear of accessing hospitals. Curiously, only endovascular procedures for AIS have increased, possibly due to reduced physical activity or increased thrombosis in SARS-CoV-2. The confounding effect of thrombectomy increase over time cannot be excluded. No conclusion can be drawn on AIS incidence. Active monitoring with nasopharyngeal swabs, wearing face masks, and using separate pathways for infected patients reduce the risk of infection.

Intensive Care Unit Capacity, Cancellation of Elective Surgery, and the US Pandemic Response.

Intensive Care Unit Capacity, Cancellation of Elective Surgery, and the US Pandemic Response.

Cochlear Implant Surgery During the Covid Pandemic Lockdown-The KEM Hospital, Pune Experience.

In response to the Covid 19 pandemic many governments and professional bodies recommended cancellation of elective surgeries including cochlear implantation. Resumption of elective surgeries was recommended after appropriate permissions were given by the authorities and the hospital had adequate infrastructure in terms of equipment and manpower to start elective surgeries without compromising on patient safety and care. We began cochlear implant surgeries in April 2020. We have done 5 cochlear implants surgeries till date. This manuscript discusses the changes that we did in our preoperative, intraoperative and postoperative protocol.

Backlog to Surgery due to COVID-19 and Considerations to Address to Catch-up Safely

On March 11th 2020, COVID-19 met all criteria to be considered a pandemic. The resulting halt in surgery led to an estimated 28.4 million elective surgery cancellations around the globe. Figures suggest that the backlog to surgery may take years to clear, causing huge detrimental effects to both the economy and the health of patients. Addressing this surgical backlog, whilst ensuring the health and safety of healthcare professionals and patients during surgery, will require a multifaceted approach. Key aspects, such as providing a sufficient and stable supply of Personal Protective Equipment (PPE), adequate and efficient testing of healthcare staff and patients, and availability of post-acute care, need to be secured before surgery can recommence safely in this COVID-19 era.

Causas institucionais para cancelamento de cirurgias eletivas

Objetivo: Analisar as produções científicas sobre cancelamento de cirurgias eletivas pelas causas institucionais. Método: Revisão integrativada literatura, sistematizada pelo acrônimo Participante, Interesse e Contexto (PICo), de acordo com a estratégia PICo e procedimentos definidos peloPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A busca bibliográfica foi realizada em setembro de 2018 e atualizadaem maio de 2020, nas bases de dados Sistema Online de Busca e Análise de Literatura Médica (MEDLINE)/PubMed, Literatura Latino-Americana e doCaribe em Ciências da Saúde (Lilacs) e Base de Dados em Enfermagem (BDEnf ) da Biblioteca Virtual em Saúde (BVS), Scopus (Elsevier) do Portal dePeriódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) e Biblioteca Eletrônica Científica Online (SciELO). Foram consideradaspublicações de 2008 até 2020, nos idiomas português, inglês e espanhol. Resultados: Foram identificados, na busca bibliográfica, 920 estudos,sendo 263 duplicados, restando 657 para seleção. Ao final, foram incluídos 15 estudos na síntese. Conclusão: As causas institucionais identificadas foramo avanço de horário da cirurgia anterior, gerando a indisponibilidade de salas cirúrgicas, problemas estruturais, falta ou defeitos em equipamentos erecursos humanos insuficientes.