Elective Surgical Cases Research Articles

Impact of COVID-19 pandemic in management of Surgical patients during Nationwide COVID-19 Lockdown in a Military hospital

Introduction: The COVID-19 pandemic has had a major impact on healthcare in many countries. This study assessed the effect of a nationwide lockdown during the second wave of COVID-19 on surgical management for acute surgical conditions and the subsequent impact on postoperative mortality. Methods: This was a retrospective study, evaluating data from the hospital discharge database during the second wave of COVID -19 pandemic. All adult patients admitted through the emergency and outpatient department requiring surgical treatment between April 29 and June 29, 2021 were included in the study. The primary outcome was the change in number of hospital admissions for acute surgical conditions. Mortality was assessed among the patients with COVID-19 infected cases. Results: During the second wave of nationwide COVID-19 lockdown period, a total of 329 patients were provided surgical consultation either in emergency or outpatient basis. Among them, 227 cases required surgery. Out of this 122(53.74%) required minor surgeries and were performed in minor operation theatre in local anesthesia (LA) while 105(46.2%) underwent major surgical procedures. Of all the patients who underwent major surgical procedures 76(72.3%) were surgical emergencies, 15(14.2%) were GI and breast malignancies while 14(13.3 %) were elective cases. The mortality rate due to COVID-19 in surgical patients was 02(16.66 %) during the lockdown period. Conclusion: A decrease in hospital admissions for elective surgical cases with prioritization to emergency and malignant cases was observed during the lockdown period.

Allocating Blood Products During a Time of Remarkable Shortage

Abstract The COVID-19 Pandemic adversely impacted the nation’s blood supply such that blood suppliers could not fill standing orders. To address the dwindling blood supply, the American Red Cross (ARC) implemented daily thresholds, which distributed red blood cells (RBCs) based on clients’ historical blood orders and the ARC’s inventory. The threshold system left the blood bank to devise a process to judiciously allocate the reduced RBC supply across our institution. Herein, we describe an internal RBC utilization audit, the data from which we used to devise an algorithm to predict our ability to meet transfusion requirements for operating room (OR) procedures. An OR adjudication committee used our report to prioritize elective surgical cases taking places the following day. Thirty-one non-consecutive days of blood inventory release slips were reviewed across three months of recent transfusions. Weekdays were disproportionally investigated to predict the blood utilization for days with scheduled OR procedures. For all RBCs released, the blood type requested and the final disposition (transfused vs returned to blood bank) of the units were recorded. Average use was calculated as well as interquartile range (IQR) to account for transfusion variability. Utilization data was then used to develop a worksheet-based tool to predict ability to meet RBC requirements. Overall, the hospital transfused an average of 80 RBC units each weekday (IQR: 64-92 units). Approximately 40% of all requested RBC units were released to the OR. In turn, the OR transfused only 39% of the RBCs released to them, which represented 20% of transfusions hospital-wide. The OR requested an average of 41 RBC units each weekday (IQR: 25-57 units). The OR transfused an average of 16 units of RBCs each weekday (IQR: 9-21 units). The outpatient cancer center infusion clinic used less than 15% of total RBCs. The biggest user of RBCs were inpatients, who were transfused 65% of RBCs during the week and 82% of transfusions during the weekend. These percentages and the average-to-third-quartile range were used to devise a blood allocation algorithm to inform the OR if the blood bank could support anticipated use. The data was also used to devise a blood allocation worksheet for the on-call transfusion medicine physicians to predict our ability to provide adequate blood for emergent, non-elective procedures that require transfusion support such as liver transplants and aortic repairs. The audit of RBC disposition informed blood inventory management practices during a time of remarkable shortage. Within the confines of the threshold system, the transfusion medicine service allocated the expected number of units based on historical request and transfusion data to predict whether inventory levels could support scheduled and nonscheduled OR procedures.

I-GEL versus LMA classic: Comparison of two supraglottic airway devices in short surgical procedures

Background: Supraglottic airway devices are more efficient than endotracheal intubation in management of difficult airway and hemodynamic response. Aims and Objectives: This study was undertaken for to compare laryngeal mask airway (LMA) Classic and I-Gel in terms of ease of insertion, insertion attempts, time taken for insertion, hemodynamic change, and adverse events after administering muscle relaxants for airway management in short surgical procedures. Materials and Methods: A total of 120 patients of American Society of Anaesthesiologist 1 and II, aged between 18 and 50 years with Malampatti score 1 and II posted for elective short surgical cases were randomly allotted into two groups (n=60 in each), Group A for LMA Classic and Group B for I-gel. Patients were pre oxygenated with 100% O2 and pre-medicated. After induction and proper muscle relaxation, LMA Classic or I-GEL was inserted. The time and number of insertion attempts were assessed. Heart rate, Blood pressure, SpO2 recorded at the time of insertion, 1, 3, 5, and 10 min following insertion. The recorded results were analyzed statistically. Results: The mean insertion time of Group A was 34.80±3.193 and Group B was 21.72±1.975. P<0.001 and in Group B all patients were successfully intubated at first attempt whereas in Group B 23.33% patients required second attempts. Hemodynamic changes were also less with Group B. Conclusion: I-Gel has better hemodynamic stability. Ease of Insertion, insertion attempts and time taken for insertion are more convenient for I-Gel than LMA Classic after administering muscle relaxants.

Surgical site infection in emergency and elective patients and it’s major risk factor in resource limited tertiary care center

Postoperative surgical site infection (SSI) is major threat for surgeons. In this study, we measure the incidence of SSI in emergency and elective surgical patients and evaluation of any significant relation to anemia, hypoalbuminemia, Diabetes mellites, alcohol and tobacco user. This study was a prospective comparative study of 200 patients, studied during a twelve-month duration who were admitted and operated in our departments. Data collected including demographic profile and presence of SSI up to 30 postoperative days. In this prospective study of 200 patients (100 patients in each emergency and elective surgical case) surgical site infection was present in 17% (n=34) of patients, out of 34 SSI patients 64.7% (22 Patients) were male and 35.3% (12 Patients) were female. SSI was present in 73.5% and 26.5% of emergency and elective surgical cases respectively. Emergency and elective surgical cases were compared in SSI and non SSI cases and data showed a statistically significant difference (X2= 9.0716, P value .00256). Patients having SSI were compared with non SSI for anemia, hypoalbuminemia and diabetes mellites data showed statistically significant difference (X2=66.6, P value< 0.00001, X2=78.5, P value< 0.00001 and X2 =61.7, P value< 0.00001 respectively).

AOA Critical Issues Symposium: Deficit Recovery for the Orthopaedic Service Line.

The COVID-19 pandemic and the mandated cessation of surgical procedures for a substantial portion of the 2020 year placed tremendous strain, both clinically and financially, on the health-care system in the United States. As a surgical specialty that accounts for nearly a quarter of all hospital net income, the revenue recovery of orthopaedic service lines (OSLs) is of particular importance to the financial recovery of their broader health-care institutions. In this American Orthopaedic Association (AOA) symposium report, the OSL leaders from 4 major academic medical institutions explain and reflect on their approaches to address their revenue deficits. Cost-reduction strategies, such as tightening budgets, adopting remote-work models, and limiting costs of human capital, were vital to stabilizing departmental finances at the onset of the pandemic, while strategies that focused on expanding surgical volume, such as those that improve efficiency in clinical and surgical settings, were important in growing revenue once elective procedures resumed. Institutional policy, payer administrative procedures, and the overall context of an ongoing public health crisis all placed limitations on recovery efforts, but engaging relevant stakeholders and working with available resources helped OSLs overcome these limitations. Due to clear strategic actions that were taken to address their deficits, each OSL represented in this AOA symposium saw substantial improvement in its year-end financial performance compared with its financial status at the end of the period of mandatory cessation of elective surgical cases.

Magnitude and reasons of surgery cancellation among elective surgical cases in Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia, 2021

BackgroundCancellations of cases are common; most of those cancellations are due to avoidable causes. It is a major cause of psychological trauma for patients and their families. Although little is known in Ethiopia, the aim of this study is aimed to assess the prevalence and the cause of elective surgery cancellation.MethodsA cross-sectional prospective study design was conducted on 326 patients scheduled for elective surgery from October 1 to December 1st. All consecutive elective surgical cases scheduled during the study period were included in the study. Data were collected using a prepared and pretested questionnaire and entered into SPSS version 23 for analysis. The result of the study was reported in the form of text, tables, and graphs.ResultDuring the study, 326 patients were scheduled for elective surgery, among those, 83(25.6%) of surgery was canceled. Patient-related (31.32%) and administrative-related (26.5%) factors were the two most causes of cancellation.ConclusionPatient-related and administrative-related factors were the leading causes of cancellation of elective surgical operations in our hospital. Concerned bodies should bring a sustainable change and improvement to prevent unnecessary cancellations and enhance cost-effectiveness through communications, careful planning and efficient utilization of the available hospital resources.

Study Comparing Effect of Single Dose Antibiotic Prophylaxis versus Conventional Antibiotic Coverage in Clean, Elective Surgeries – A Randomized Controlled Clinical Trial

BACKGROUND
 Postoperative wound infection remains the most common complication of surgery. With the fear of developing wound infection after surgery, many surgeons administer antibiotics for 7 -10 days even in clean uncontaminated cases. This practice is not only expensive to the patients but also can lead to hospital-acquired infections. We wanted to assess the effectiveness and efficacy of single-dose antibiotics in clean elective surgical cases in this study.
 METHODS
 A prospective interventional study was conducted in the General Surgery department, SRM Medical College Research Centre, Kattankulathur for a period of 18 months between May 2018 and October 2019. In this study, 143 patients were selected according to the inclusion criteria. All the data findings were recorded and analysed.
 RESULTS
 Out of 143 patients presented with clean cases, 72 cases were included in the study group and 71 cases in the control group as per the inclusion criteria. In the present study, the incidence of postoperative infection was equal i.e., 6 % in both groups. However, the grade of infection varied. The difference was not statistically significant.
 CONCLUSIONS
 Based on my study I would like to conclude that it is recommendable to use single-dose antibiotic prophylaxis for clean surgical cases, as per the study results there is not much difference in the occurrence of SSI when compared to multiple doses.

Cost of postoperative ileus following colorectal surgery: A cost analysis in the Australian public hospital setting.

Postoperative ileus (POI) following surgery results in significant morbidity, drastically increasing hospital costs. As there are no specific Australian data, this study aimed to measure the cost of POI after colorectal surgery in an Australian public hospital. A cost analysis was performed, for major elective colorectal surgical cases between 2018 and 2021 at the Royal Adelaide Hospital. POI was defined as not achieving GI-2, the validated composite measure, by postoperative day 4. Demographics, length of stay and 30-day complications were recorded retrospectively. Costings in Australian dollars were collected from comprehensive hospital billing data. Univariate and multivariate analyses were performed. Of the 415 patients included, 34.9% (n=145) developed POI. POI was more prevalent in males, smokers, previous intra-abdominal surgery, and converted laparoscopic surgery (p < 0.05). POI was associated with increased length of stay (8 vs. 5 days, p < 0.001) and with higher rates of complications such as pneumonia (15.2% vs. 8.1%, p=0.027). Total cost of inpatient care was 26.4% higher after POI (AU$37,690 vs. AU$29,822, p < 0.001). POI was associated with increased staffing costs, as well as diagnostics, pharmacy, and hospital services. On multivariate analysis POI, elderly patients, stoma formation, large bowel surgery, prolonged theatre time, complications and length of stay were predictive of increased costs (p < 0.05). In Australia, POI is significantly associated with increased complications and higher costs due to prolonged hospital stay and increased healthcare resource utilisation. Efforts to reduce POI rates could diminish its morbidity and associated expenses, decreasing the burden on the healthcare system.

Non-COVID surgical load of operation theatre during COVID-19 pandemic in Armed Forces tertiary care centres: “Snapshot of two timelines”

BackgroundThe global COVID-19 pandemic has led to major changes in the surgical caseloads in the operation theatres across the world. Elective surgeries have been curtailed to a great extent and the number of emergency surgeries has risen. We conducted a study to assess the changes in the surgical caseloads in two tertiary care hospitals in India during the pandemic and to assess the changes in anaesthesia techniques used. MethodsA multicentre retrospective observational study conducted at two tertiary care centres located 1500 kms apart. Hospital A in a city with high incidence of COVID-19 and Hospital B with a lighter load of COVID-19 cases. Record of all major surgeries carried out between 01Jul 2020 and 31 Dec 2020 were compared with the surgeries carried out between 01 Jul 2019 and 31 Dec 2019. ResultsThere was a decrease of almost 53% in elective surgical workload in hospital A and 71% in hospital B. The decrease in the cases was not similar across all specialities. There was a significant increase in the percentage of emergency surgeries from 11.1% to 24% in hospital A and from 22.1% to 29.8% in hospital B in the year 2020. A statistically significant increase in regional anaesthesia and neuraxial blockade was noted in the year 2020 in both the hospitals. ConclusionDuring the COVID-19 pandemic, the number of elective surgical cases has significantly decreased in specialities like ophthalmology whereas there was no change in the surgical workload in specialities like obstetrics, oncology, orthopaedics, and neurosurgery. There was significant increase in the use of regional and neuraxial techniques of anaesthesia.

The Impact of the COVID-19 Pandemic on Hepatobiliary and Pancreatic Surgical Services in Singapore: Retrospective Quantitative Study.

BackgroundAt the height of the COVID-19 pandemic, the hepatopancreatobiliary (HPB) unit had to reorganize its surgical case volume due to the rationing of health care resources. We report on a local audit evaluating the impact of COVID-19 on the HPB unit and the HPB surgical oncology practice.ObjectiveThe aim of this study was to review the impact of the COVID-19 pandemic on the HPB unit’s elective and emergency surgical cases. The secondary aims were to investigate the impact on the HPB surgical oncology operative case volume.MethodsWe performed a comparative audit of the HPB unit surgical case volume for January-June 2019 (baseline) and 2020 (COVID-19). Elective and emergency cases performed under general anesthesia were audited. Elective cases included hernia and gallbladder operations and liver and pancreatic resections. Emergency cases included cholecystectomies and laparotomies performed for general surgical indications. We excluded endoscopies and procedures done under local anesthesia. The retrospective data collected during the 2 time periods were compared. This study was registered in the Chinese Clinical Trial Registry (ChiCTR2000040265).ResultsThe elective surgical case volume decreased by 41.8% (351 cases in 2019 compared to 204 cases in 2020) during the COVID-19 pandemic. The number of hernia operations decreased by 63.9% (155 in 2019 compared to 56 in 2020; P<.001) and cholecystectomies decreased by 40.1% (157 in 2019 compared to 94 in 2020; P=.83). The liver and pancreatic resection volume increased by 16.7% (30 cases in 2019 compared to 35 cases in 2020; P=.004) and 111.1% (9 cases in 2019 compared to 19 cases in 2020; P=.001), respectively. The emergency surgical workload decreased by 40.9% (193 cases in 2019 compared to 114 cases in 2020). The most significant reduction in the emergency workload was observed in March (41 to 23 cases, a 43.9% reduction; P=.94), April (35 to 8 cases, a 77.1% reduction; P=.01), and May (32 to 14 cases, a 56.3% reduction; P=.39); however, only April had a statistically significant reduction in workload (P=.01).ConclusionsThe reallocation of resources due to the COVID-19 pandemic did not adversely impact elective HPB oncology work. With prudent measures in place, essential surgical services can be maintained during a pandemic.Trial RegistrationChinese Clinical Trial Registry (ChiCTR2000040265); https://tinyurl.com/ms9kpr6x

Minimum Case Numbers: The New Pandemic in a Changing Clinical Environment.

Minimum Case Numbers: The New Pandemic in a Changing Clinical Environment.

Prioritizing Elective Surgical Cases During a Pandemic or Global Crisis: The Elective-Pediatric Orthopedic Surgical Timing (E-POST) Score.

As the first wave of the COVID-19 pandemic stabilized and resources became more readily available, elective surgery was reinitiated and hospitals realized that there was little guidance on how to prioritize elective cases. A prioritization tool was formulated based on clinically relevant elements and previous literature. Nine pediatric orthopaedic surgeons from North American institutions evaluated 25 clinical scenarios on 2 occasions separated in time. Intra-rater and inter-rater reliability were calculated [intraclass correlation coefficient (ICC)]. Surgeons also ranked the importance of each element and how confident they were with scoring each factor. Intra-rater ICC for total score showed good to excellent consistency; highest at 0.961 for length of stay (LOS) and lowest at 0.705 for acuity. Inter-rater ICC showed good to excellent agreement for American Society of Anesthesiologists score, LOS, duration of surgery, and transfusion risk and moderate agreement for surgical acuity and personal protective equipment (PPE) use. Transfusion risk and duration of surgery were deemed least important, and surgeons were least confident in scoring PPE and transfusion risk. Based on findings, the novel Elective-Pediatric Orthopedic Surgical Timing (E-POST) score for prioritizing elective cases was developed, consisting of 5 factors: surgical acuity, global health status, LOS, duration of surgery, and PPE requirement. The E-POST numeric total score or subscore may help objectively prioritize elective cases during a global crisis. Level V.

Similarities Between Pediatric and General Hospitals Based on Fundamental Attributes of Surgery Including Cases Per Surgeon Per Workday.

IntroductionOperating room (OR) management decision-making at both pediatric and adult hospitals is determined, in large part, by the same fundamental attributes of surgery and other considerations related to case duration prediction. These include the non-preemptive nature of surgeries, wide prediction limits for case duration, and constraints to moving or resequencing cases on the day of surgery. Another attribute fundamentally affecting OR management is the median number of cases a surgeon performs on their OR days. Most adult surgeons have short lists of cases (i.e., one or two cases per day). Similarly, at adult hospitals, growth in caseloads is mostly due to the subset of those surgeons who also operate just once or twice per week. It is unknown if these characteristics of surgery apply to pediatric surgeons and pediatric hospitals as well.MethodsOur retrospective cohort study included all elective surgical cases performed at the six pediatric hospitals in Florida during 2018 and 2019 (n = 71,340 cases). We calculated the percentages of combinations of surgeon, date, and hospital (lists) comprising one or two cases, or just one case, and determined if the values were statistically >50% (i.e., indicative of “most”). We determined if most of the growth in caseload and intraoperative work relative value units (wRVUs) at the pediatric hospitals between 2018 and 2019 accrued from low-caseload surgeons. Results are reported as mean ± standard error of the mean.ResultsAveraging among the six pediatric hospitals, the non-holiday weekday lists of most surgeons at each facility had just one or two elective cases, inpatient and/or ambulatory (68.1%; p = 0.016 vs. 50%, n = 27,557 lists). Growth in surgical caseloads from 2018 to 2019 was mostly attributable to surgeons who in 2018 averaged ≤2.0 cases per week (76.3% ± 5.4%, p = 0.0085 vs. 50%). Similarly, growth in wRVUs was mostly attributable to these low-caseload surgeons (73.8% ± 5.4%, p = 0.017 vs. 50%).ConclusionsLike adult hospitals, most pediatric surgeons’ lists of cases consist of only one or two cases per day, with many lists containing a single case. Similarly, growth at pediatric hospitals accrued from low-caseload surgeons who performed one or two cases per week in the preceding year. These findings indicate that hospitals desiring to increase their surgical caseload should ensure that low-caseload surgeons are provided access to the OR schedule. Additionally, since percent-adjusted utilization and raw utilization cannot be accurately measured for low-caseload surgeons, neither metric should be used to allocate OR time to individual surgeons. Since most adult and pediatric surgeons have low caseloads, this is a fundamental attribute of surgery.

Trends in outpatient shoulder arthroplasty during the COVID-19 (coronavirus disease 2019) era: increased proportion of outpatient cases with decrease in 90-day readmissions.

BackgroundThe COVID-19 (coronavirus disease 2019) pandemic has placed an increased burden on health care resources, with hospitals around the globe canceling or reducing most elective surgical cases during the initial period of the pandemic. Simultaneously, there has been an increased interest in performing outpatient total joint arthroplasty in an efficient manner while maintaining patient safety. The purpose of this study was to investigate trends in total shoulder arthroplasty (TSA) during the COVID-19 era with respect to outpatient surgery and postoperative complications.MethodsWe conducted a retrospective chart review of all primary anatomic and reverse TSAs performed at our health institution over a 3-year period (January 2018 to January 2021). All cases performed prior to March 2020 were considered the “pre–COVID-19 era” cohort. All cases performed in March 2020 or later comprised the “COVID-19 era” cohort. Patient demographic characteristics and medical comorbidities were also collected to appropriately match patients from the 2 cohorts. Outcomes measured included type of patient encounter (outpatient vs. inpatient), total length of stay, and 90-day complications.ResultsA total of 567 TSAs met the inclusion criteria, consisting of 270 shoulder arthroplasty cases performed during the COVID-19 era and 297 cases performed during the pre–COVID-19 era. There were no significant differences in body mass index, American Society of Anesthesiologists score, smoking status, or distribution of pertinent medical comorbidities between the 2 examined cohorts. During the COVID-19 era, 31.8% of shoulder arthroplasties were performed in an outpatient setting. This was significantly higher than the percentage in the pre–COVID-19 era, with only 4.5% of cases performed in an outpatient setting (P < .0001). The average length of stay was significantly reduced in the COVID-19 era cohort (0.81 days vs. 1.45 days, P < .0001). There was a significant decrease in 90-day readmissions during the COVID-19 era. No significant difference in 90-day emergency department visits, 90-day venous thromboembolism events, or 90-day postoperative infections was observed between the 2 cohorts.ConclusionWe found a significant increase in the number of outpatient shoulder arthroplasty cases being performed at our health institution during the COVID-19 era, likely owing to a multitude of factors including improved perioperative patient management and increased hospital burden from the COVID-19 pandemic. This increase in outpatient cases was associated with a significant reduction in average hospital length of stay and a significant decrease in 90-day readmissions compared with the pre–COVID-19 era. The study data suggest that outpatient TSA can be performed in a safe and efficient manner in the appropriate patient cohort.

Patient Engagement Towards Delivery of Quality Care - A Study Amongst Elective Surgical Cases in Two Private Hospitals in India

Background Patients and their families may play a major role in the improvement of healthcare outcome. Modern healthcare scenario focuses on enhancing patient well-being with a closer participation between payer and provider. ldquoNothing about me is without merdquo is the true essence of healthcare which requires first-hand knowledge of the ailment treatment options risks and benefits and a host of other information for the patients to be completely involved in the care process.Objectives To assess the level of involvement of patients undergoing elective surgeries during the phases such as surgical decision making written consent and post-surgical recovery.Methodology The present study was conducted at two tertiary care hospitals in India with a sample size of 50 each from the selected surgical specializations. Structured questionnaires were designed to obtain relevant data from the participants admitted under selected surgical specialisations. Data was collected to assess their involvement at three phases viz. pre surgical decision making written consent and post-surgical recovery phases. Data from all three phases were compiled and the involvement of patients was computed in terms of percentage using descriptive statistics. Chi-square test was performed to determine the association between patient involvement and demographic variables. Significance level at 5.Results The study showed good involvement of patients at all the three levels with ge75 score. However association was not found between demographic variables and the level of involvement.Conclusion Many patients felt the need to receive more information regarding post-operative recovery time post-operative diet care for incision site and post-operative movement or exercises.

How did the first year of the COVID-19 pandemic affect urology practice in Arab countries? A cross-sectional study by the Arab Association of Urology research group.

Objective:The aim of this study was to assess of the effect of coronavirus disease 2019 (COVID-19) pandemic on urology practice in the Arab world during the first year of the crisis.Methods:An Internet-based questionnaire was created and sent out via email to members of the Arab Association of Urology (AAU) using ‘Google Forms’. The survey assessed participants’ demographics in terms of age, gender, country of origin, type of practice and position. Impacts of COVID-19 on urological practice were assessed in terms of the changes in hospital policies regarding consultations, and elective and emergency surgical cases. Moreover, impacts of COVID-19 on urologists were assessed.Results:A total of 255 AAU members across 14 Arab countries (Emirates, Egypt, Saudi Arabia, Iraq, Jordan, Algeria, Kuwait, Yemen, Qatar, Lebanon, Libya, Oman, Sudan and Syria) completed the survey; 4% were female urologists. Consultations at outpatient clinics were closed or restricted to emergency cases or replaced by telemedicine in almost 15%, 40% and 25% of hospitals, respectively. Elective surgeries were stopped or reduced to under 25% of surgical capacity in >10% and about 25% of hospitals, respectively. Almost 90% (228) reported changes in the policy for emergency theatres. Nearly 65% of hospitals offered preoperative COVID-19 testing to patients and 50% of hospitals provided personal protective equipment (PPE) to their urologists. Of 99% (253) who reported a change in urological education, 95% relied on online webinars. About 56% of respondents had their own private practice, of whom 91% continued private practice during the crisis. About 38% of participants reported exposure to intimidation (75% emotional, 20% verbal and 5% physical).Conclusion:The COVID-19 pandemic resulted in major changes in hospitals’ policies regarding outpatient consultations, elective and emergency operative cases, and the shift to telemedicine. Arab urologists have been facing major challenges either in both the governmental or the private sectors, and some of them were exposed to emotional, verbal and even physical intimidation.

A Rolling-Horizon Approach for a Surgery Case Scheduling Problem with Sterilizing Constraints

In this paper, we study a real scheduling problem which consists in scheduling a set of elective surgical cases that arrive over the time taking into account the uncertainties on their duration, and the delay to sterilize surgical instruments. The objectives are to schedule as many surgeries as possible, and to minimize the overtime of the surgical block staff and the number of instruments processed in emergency in the sterilizing unit. This research was performed in collaboration with the University Hospital of Angers in France, which has also provided historical data for the experiments. We propose a rolling horizon approach based on the iterative resolution of a robust mixed integer linear programming model, in which the objective functions are taken into account in a lexicographic order. The experiments on real data show a reduction of more than 50% of overtime, and around 87% less stress situations in the sterilizing unit.

Assigning green hospitals during the COVID-19 pandemic assure continuous and safe resumption of surgical services

BackgroundCoronavirus 19 pandemic impacted the health system with more pressure on the critical areas, leading to direct manpower working in the Operating Room to help treat this new problem by postponing elective surgical cases and affecting some urgent ones. However, elective surgical services start to recover by establishing one or more hospitals that deal with COVID-19 free patients (green hospital) in each area with a dedicated one to treat COVID19 cases. Our research shows if this model's application assures safe and continued recovery of surgical services to reach the level before the pandemic. This study aimed to explore if assigning a green hospital to assure safe and continuous resumption of surgical services during a pandemic. MethodsThis study used a multicenter, national, quasi-experimental, post-test-only control group design. All hospitals assigned at least one hospital as a green hospital (COVID-19 free hospital) in the northern areas of Saudi Arabia were included in the study. We also included Riyadh's large tertiary care hospital as a control none green hospital. We reported the number of surgical backlog in each city, the number of surgical cases performed, the percentage of OR utilization in each city and the percentage of COVID-19 cases to the number of ICU bed cases in each city. ResultsThis study included green hospitals in five cities in the northern area of Saudi Arabia. Besides, we included one none large green hospital in Riyadh city as a control group. The median of weekly procedures in green hospitals was 101 (99, 109.5) in Alqurayat, 233 (194, 237) in Tabuk, 180 (162, 199) in Haill, 108 (90, 120) in Al Jawf and 257 (155, 313) in Northern Borders. The median of weekly procedures in the control hospital was 245 (215, 259). Green hospitals contributed to reducing the surgical backlog by a median percentage of 74% (38, 108) in Alqurayat, 25% (21, 26) in Tabuk, 8% (7, 9) in Haill, 81% (54, 91) in Al Jawf and 78% (72, 88) in Northern Borders. While in the control hospital was 8% (8, 9). ConclusionImplementing elective surgeries in green hospitals contributes to a continuous resumption of surgical services during the COVID-19 pandemic.

Letter: Home-Turf Advantage? The Neurosurgery Residency Match During the COVID-19 Pandemic.

Letter: Home-Turf Advantage? The Neurosurgery Residency Match During the COVID-19 Pandemic.

Development and Validation of an Electronic Health Record-based Score for Triage to Perioperative Medicine.

To develop an electronic health record-based risk model for perioperative medicine (POM) triage and compare this model with legacy triage practices that were based on clinician assessment. POM clinicians seek to address the increasingly complex medical needs of patients prior to scheduled surgery. Identifying which patients might derive the most benefit from evaluation is challenging. Elective surgical cases performed within a health system 2014- 2019 (N = 470,727) were used to develop a predictive score, called the Comorbidity Assessment for Surgical Triage (CAST) score, using split validation. CAST incorporates patient and surgical case characteristics to predict the risk of 30-day post-operative morbidity, defined as a composite of mortality and major NSQIP complications. Thresholds of CAST were then selected to define risk groups, which correspond with triage to POM appointments of different durations and modalities. The predictive discrimination CAST score was compared with the surgeon's assessments of patient complexity and the American Society of Anesthesiologists class. The CAST score demonstrated a significantly higher discrimination for predicting post-operative morbidity (area under the receiver operating characteristic curve 0.75) than the surgeon's complexity designation (0.63; P < 0.001) or the American Society of Anesthesiologists (0.65; P < 0.001) ( Fig. 1 ). Incorporating the complexity designation in the CAST model did not significantly alter the discrimination (0.75; P = 0.098). Compared with the complexity designation, classification based on CAST score groups resulted a net reclassification improvement index of 10.4% ( P < 0.001) ( Table 1 ). A parsimonious electronic health record-based predictive model demonstrates improved performance for identifying pre-surgical patients who are at risk than previously-used assessments for POM triage.