Time Of Incision Research Articles

The association between decision and incision time by race and ethnicity.

Identifying and reducing inequities in the delivery of care is crucial to improving health disparities in obstetric outcomes. This study sought to evaluate the effect of race and ethnicity on time from decision for cesarean delivery to incision following implementation of a case classification system. A retrospective cohort study was performed to identify women who had cesarean deliveries from October 1, 2020, to March 31, 2021, at a single, tertiary care institution. Medical records were reviewed for demographics and cesarean delivery case classification. Case classification was divided into STAT cesarean delivery (within 10 minutes), level A (within 30 minutes), level B (within 60 minutes), or scheduled/unscheduled other. The "decision to incision time" was determined from the time the case surgical order was placed to the case start time. There were 565 eligible individuals who had a cesarean delivery during the study period, with 13.6% identifying as Black/African American, 29.0% as Hispanic/Latina, and 57.3% as White. Hispanic women were more likely to need interpreter services than other race/ethnicity groups. There was no statistically significant difference in "decision to incision time" by race/ethnicity. Within the total cohort, 51.8% of cesarean delivery cases went within the goal time according to case classification, which also did not differ by race/ethnicity. Race and ethnicity do not impact cesarean delivery "decision to incision time" or case classification. Only half of cesarean deliveries went within the goal time, so further evaluation to improve workflow and improve this metric for all patients is needed.

Fascia iliaca compartment block mitigates the fluctuations in heart rate variability and reduces pain with opioid consumption in elderly individuals with hip fractures: A randomized controlled trial

BackgroundHip fractures, commonly known as the “terminal fracture of life,” frequently necessitate prompt surgical intervention and are accompanied by significant perioperative pain. ObjectiveThis investigation was performed to assess the impact of fascia iliaca compartment block (FICB) on heart rate variability during the perioperative period in elderly individuals with hip fractures. DesignSingle-center, randomized, controlled clinical trial. SettingThe study was conducted from September 2021 to February 2023 at one tertiary care hospital in China. ParticipantsPatients aged ≥60 years who underwent general anesthesia for hip fracture surgery were screened for enrollment. Eighty patients were initially assessed for eligibility, 70 underwent randomization, and 62 were included in the final analysis. MethodsPreoperatively, the patients were randomly allocated to either receive (Group F) or not receive (Group C) ultrasound-guided suprainguinal FICB. The primary endpoint was heart rate variability indicators at the corresponding time points. The secondary endpoints included the mean arterial pressure and heart rate measured at different time points [upon admission to the operating room (T1), during positioning (T2), at the time of skin incision (T3), 30 min after the start of surgery (T4), and 6 h postoperatively (T5)] and visual analogue scale (VAS) score, dose of oral pain medication over 24 h, and satisfaction scores were valued. ResultsCompared with Group C, Group F had a significantly reduced low-frequency band, high-frequency band, and low-/high-frequency band ratio at T3, T4, and T5 (P < 0.05). Group F also had a lower heart rate at T2, T3, T4, and T5 (P < 0.05). Moreover, Group F had lower flurbiprofen dosages at 24 h postoperatively (P < 0.05) and lower resting VAS scores at 6 and 24 h postoperatively (P < 0.05). ConclusionUtilization of ultrasound-guided FICB has the potential to yield efficacious analgesic effects, mitigate the pronounced fluctuations in heart rate induced by surgical stimulation, and maintain autonomic function stability to a certain degree.

Evaluation of the safety, efficacy and technical advantages of spinal anesthesia in patients undergoing single lower lumbar level minimally invasive transforaminal lumbar interbody fusion, as an alternative to general anesthesia: a prospective study

Background: In spinal anesthesia, patients experience shorter OT, quicker recovery and ambulation, better post-operative analgesia and fewer complications than general anesthesia. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) shows fewer complications and early ambulation than open TLIF. Our study aims to assess spinal anesthesia’s safety, efficacy and technical benefits in MIS-TLIF. Methods: Patients unresponsive to conservative treatment for 6-8 weeks underwent MIS TLIF for lower lumbar degenerative pathologies. The demographic data, OT entry to incision time, blood loss, bandaging to exit from OT time, post anesthesia care unit (PACU) time, post-op complications, requirement of analgesia, visual analogue scale (VAS) and Oswestry disability index (ODI) scores, hospital stay, fusion rates and satisfaction scores were noted and assessed. Results: The study included a total of 200 patients undergoing MIS-TLIF with mean age being 54.32±10.36 years; mean surgery time being 165.23±21.41 minutes; and mean blood loss being 123.56±65.14 ml. The mean OT entry to incision time was 28.91±9.63 minutes, while the mean bandaging to exit time was 7.43±4.12 minutes. The mean PACU stay was 41.35±5.78 minutes. The mean hospital stay was 3.28±1.23 days, with 97% patients showing solid radiographic fusion while 92.5% patients were fully satisfied with the surgery. VAS and ODI scores were significantly improved as compared to the pre operative status. Conclusions: Spinal anesthesia for lower lumbar MIS-TLIF is cost effective and safe alternative to general anesthesia with lesser post operative pain and other side effects; taking into consideration proper patient selection for the same.

Locking plate versus K-wires and cast fixation in lateral closing-wedge osteotomy for cubitus varus deformity.

The aim of this study was to assess the clinical and radiographic outcomes of cubitus varus treatments based on different fixation methods: Locking plate vs. Kirschner-wires (K-wires) and cast fixation. This retrospective study of 28 patients was performed in lateral-wedge osteotomy for cubitus varus deformity in our hospital from July 2018 to July 2020. 14 patients in group A were treated by locking plate after lateral closing-wedge osteotomy, whereas other 14 patients were treated by K-wires in group B. We measured the bony union and carrying angle. The clinical and radiographic outcomes were assessed according to the Bellemore criteria. No nonunion, neurovascular injury or myositis ossificans was noted at follow-up. In group A, 1 patient with lateral condylar prominence was found. In group B, 2 patients with pinning site infection were treated successfully with oral antibiotics and 2 patients needed revision surgery for residual varus. According to the Bellemore criteria, statistically significant difference was noted between the two groups (P = 0.0458). In the present study, no statistically significant difference was noted in the length of incision and operation time between the 2 groups (P > 0.05). However, the postoperative carrying angle was significantly different at final follow-up between the 2 groups (P < 0.01). Compared with K-wires and cast fixation, we recommend the wedge osteotomy with lateral locking plate to treat the cubitus varus deformity because locking plate could achieve better functional and cosmetic results and stabilize the distal humerus rigidly.

Diathermy versus Scalpel Skin Incision for Open Inguinal Hernia Surgery: An Interventional Study

Introduction: Inguinal hernia is one of the most encountered surgical-related problems worldwide. For years, there has been debate among surgeons about which type of skin incision to use: cutting with electrocautery or the traditional method of a surgical scalpel. Aim: To compare the skin incisions made with electrocautery versus traditional scalpel incisions in terms of incision time, blood loss, postoperative pain, and scar evaluation. Materials and Methods: A hospital-based prospective interventional study was conducted at the Department of General Surgery, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India, from November 2019 to September 2021. Written informed consent was obtained from 130 consecutive cases scheduled for open inguinal hernia surgery. Patients were alternately assigned to undergo incision with electrocautery (group A) or a conventional steel scalpel (group B), with each group comprising 65 patients. Bilateral hernia cases were treated as separate entities. Data analysis was performed using Microsoft Excel and Statistical Package for Social Sciences (SPSS) software version 24.0, employing the Student’s t-test and Chi-square test. A p-value of &lt;0.05 was considered statistically significant. Results: The age distribution in group A was 49.69±15.74 years and in Group B was 52.81±14.25 years. The time taken for incision in the electrocautery group was much shorter at 12.57±11.55 seconds than in the scalpel group at 20.63±2.99 seconds, with a p-value of &lt;0.001. The average amount of blood loss in group A was 1.02±0.35 mL and in group B was 2.03±0.32 mL, with a significant p-value of &lt;0.001. The postoperative pain, calculated by the Visual Analogue Scale (VAS), showed a significant difference in the early postoperative period at 6 hours after surgery in Group A at 6.58±0.9 compared to group B at 7.05±1, with a p-value of 0.005. However, no significant difference was noted between the two groups at 12, 24, and 48 hours after surgery. There was no significant difference in scar evaluation between group A and group B at 12 weeks, with a p-value of 0.673 for the patient score and 0.189 for the observer score. Conclusion: Electrocautery can be recommended for hernia skin incision due to its advantage of shorter incision time, minimal blood loss, and less early postoperative pain.

Efficiency and perceived safety of foot and ankle procedures performed on the preoperative stretcher versus operating room table.

Foot and ankle surgeons often perform minor surgeries on the preoperative stretcher instead of the operating room table. We examined whether stretcher-based and operating room table-based procedures differed with respect to operating room efficiency and staff perceptions. We retrospectively reviewed medical records of patients undergoing minor foot and ankle surgery at an ambulatory surgery centre. We collected 'time to start', the duration between patient arrival in the operating room and incision time, and 'time to exit', the duration between procedure end time and patient exit from the operating room. Staff were surveyed regarding their perceptions of stretcher-based and operating room table-based procedures. 'Time to start' was significantly shorter for stretcher-based procedures, but 'time to exit' was not. Seventeen (81%) staff members thought stretcher-based procedures increased operating room efficiency. Thirteen (62%) thought stretcher-based procedures bettered staff safety. Nineteen (91%) thought stretcher-based procedures were equivalent to or better than operating room table-based procedures for patient safety. Most (67%) would recommend stretcher-based procedures. We found small but significant time savings associated with stretcher-based procedures. Without adapting surgical scheduling practices, the impact of stretcher-based procedures on overall operating room efficiency is questionable. Nevertheless, the majority of OR staff think stretcher-based procedures increase OR efficiency and are safer for staff. Level IV, Retrospective case series.

Comparison of Electrocautery and Scalpel Incision in Midline Abdominal Surgery

Background: With the advancement of surgical techniques, the comparison of electrocautery and scalpel incisions in midline abdominal surgeries has become an essential area of study. Traditional scalpel incisions have been known for their precision but carry risks of excessive blood loss and sharp injuries. Electrocautery, offering a potentially safer and more efficient alternative, has been gaining attention in surgical practices. Objective: The primary objective of this study was to compare the effectiveness, safety, and outcomes of electrocautery versus scalpel incisions in midline abdominal surgeries, with a focus on incision time, blood loss, wound infection, and postoperative pain. Methods: A randomized controlled trial was conducted at the Military Hospital, Rawalpindi, over 12 months from June 2021 to June 2022. A total of 150 patients, split evenly into electrocautery and scalpel groups, were evaluated. Patients aged 20-75 years, undergoing midline abdominal surgery, were included. The main parameters measured were incision time, blood loss, wound infection, and postoperative pain. Data were analyzed using SPSS version 25.0, employing independent samples t-tests and chi-square tests. Results: The electrocautery group exhibited a significantly shorter incision time (13.73 ± 2.45 seconds) compared to the scalpel group (18.67 ± 3.02 seconds, p &lt; 0.001). Blood loss was also lower in the electrocautery group (11.47 ± 2.49 ml) than in the scalpel group (27.27 ± 4.13 ml, p &lt; 0.001). Wound infection rates were 6.7% for electrocautery and 13.3% for scalpel, though this was not statistically significant (p = 0.174). Remarkably, 100% of the electrocautery group reported postoperative pain, in contrast to none in the scalpel group (p = 0.000). Conclusion: The study concluded that electrocautery is more effective than scalpel incision in terms of incision time and blood loss, making it a preferable method for midline abdominal surgeries. However, the higher incidence of postoperative pain in the electrocautery group warrants further investigation.

A Multidisciplinary Protocolized Approach for Ruptured Abdominal Aortic Aneurysm Management: A Retrospective Before-After Study

To investigate whether implementation of a multidisciplinary protocol for ruptured abdominal aortic aneurysm (rAAA) management reduces rates of adverse complications. A retrospective before-after study. A tertiary-care academic hospital. Adult patients who underwent open or endovascular rAAA repair; data were stratified into before-protocol implementation (group 1: 2015-2018) and after-protocol implementation (group 2: 2019-2022) groups. The protocol details the workflow for vascular surgery, anesthesia, emergency department, and operating room staff for a rAAA case; training was accomplished through yearly workshops. The primary outcome was in-hospital mortality. Secondary outcomes included all-cause morbidity and other major complications. Differences in postoperative complication rates between groups were assessed using Pearson's χ2 test. Of the 77 patients included undergoing rAAA repair, 41 (53.2%) patients were in group 1, and 36 (46.8%) patients were in group 2. Patients in group 2 had a significantly shorter median time to incision (1.0 v 0.7 hours, p = 0.022) and total procedure time (180.0 v 160.5 minutes, p = 0.039) for both endovascular and open repair. After protocol implementation, patients undergoing endovascular repair exhibited significantly lower rates of mortality (46.2% v 20.0%, p = 0.048), all-cause morbidity (65.4% v 44.0%, p = 0.050), and renal complications (15.4% v 0.0%, p = 0.036); patients undergoing open repair for a rAAA exhibited significantly lower rates of mortality (53.3% v 27.3%, p = 0.018) and bowel ischemia (26.7% v 0.0%, p = 0.035). Implementation of a multidisciplinary protocol for the management of a rAAA may reduce rates of adverse complications and improve the quality of care.

Early effectiveness of Ti-Robot assisted femoral neck system for minimally invasive treatment of elderly Garden type Ⅱ and Ⅲ femoral neck fractures

To investigate the early effectiveness of the Ti-Robot assisted femoral neck system (FNS) in the treatment of elderly Garden type Ⅱ and Ⅲ femoral neck fractures. A retrospective analysis was conducted on the clinical data of 41 elderly patients with Garden type Ⅱ and Ⅲ femoral neck fractures who were admitted between December 2019 and August 2022 and met the selection criteria. Among them, 21 cases were treated with Ti-Robot assisted FNS internal fixation (study group), and 20 cases were treated solely with FNS internal fixation (control group). There was no significant difference in baseline data, including gender, age, side, cause of injury, time from injury to surgery, fracture Garden classification, and fracture line classification, between the two groups ( P>0.05). Surgical effectiveness was evaluated based on parameters such as operation time (including incision time and total operation time), reduction level, number of dominant pin insertions, intraoperative fluoroscopy frequency, incision length, whether to extend the incision, need for assisted reduction, postoperative hospital stay, fracture healing time, incidence of osteonecrosis of the femoral head, postoperative visual analogue scale (VAS) score at 1 day, and Harris hip score at last follow-up. The study group showed significantly shorter incision time, fewer dominant pin insertions, fewer instances of extended incisions, fewer intraoperative fluoroscopy frequency, and smaller incisions than the control group ( P<0.05). There was no significant difference in total operation time, reduction level, and assisted reduction frequency between the two groups ( P>0.05). Both groups achieved primary wound healing postoperatively, with no complications such as incision leakage or skin infection. All patients were followed up 12-24 months with an average of 14.6 months. Fractures healed in both groups, with no significant difference in healing time ( P>0.05). There was no significant difference in postoperative hospital stay between the two groups ( P>0.05). The study group showed significantly better VAS score at 1 day after operation and Harris hip score at last follow-up when compared to the control group ( P<0.05). No complication such as internal fixation failure, fracture displacement, or hip joint varus occurred in both groups during the follow-up. Osteonecrosis of the femoral head occurred in 1 patient of the control group, while no was observed in the study group, and the difference in the incidence of osteonecrosis of the femoral head between the two groups was not significant ( P=0.488). Compared to sole FNS internal fixation treatment, Ti-Robot assisted FNS internal fixation for elderly Garden typeⅡ and Ⅲ femoral neck fractures can reduce incision time, achieve minimally invasive and accurate nail implantation, and decrease intraoperative fluoroscopy frequency, leading to improved postoperative hip joint function recovery.

First experiences with a surgery supporting computer system in regard to education, efficiency and complications

PurposeSince October 2019 a computer software named SPM (surgical process manager) is used in a Level I Trauma center. Workflows were developed for distinct surgical procedures (distal radius fractures, proximal femur fractures, ankle fractures, proximal humerus fractures and vertebral fractures). In addition, these workflows were separated in a shortened „Expert“-versions for consultants and a more detailed „Learner“- versions for residents.This investigation was intended to show, if and what kind of benefits in regard to efficiency (incision to suture and suture to incision time), education and complications a surgery supporting software can bring. MethodsSPM was used in 90 cases during October 2019 to June 2022. A control trial with 108 patients was developed, including patients of the same age, having same kind of injuries, receiving the same surgery technique without using the SPM.The software was installed on the computer in the operation room, projected on head monitors and operated by a foot pedal. Complications could also be documented using the pedal.Groups were divided in surgical procedures and fracture type, qualification of the surgeon, complications and surgery time. Surgery times were taken from the hospital computer system (SAP IS-H). A statistical analysis was performed by using the chi square and Fischer exact test with significance set at a P value <0.05. ResultsIn 51 cases the software was used for the distal radius (control group 54 patients), in 20 cases for Weber fractures (control group 21 patients), in 9 cases for the proximal femur (control group 19 patients), in 5 cases for vertebral fractures (control group 7 patients) and in 5 cases for the proximal humerus (control group 6 patients).Time from incision to closure was significant higher in the intervention group (49 vs 42 min, p- value 0,018) and wasn't significant lower in the “expert” group, fixing radius and ancle fractures (39 to 46 min, p value 0,186).Comparing the SPM and control group concerning closing to incision time, no difference could be observed (56 to 58,5 min, p value 0,828).The greatest time deviation between „Learners“und „Experts“was observed in reduction and fixation (p value 0,006) in ankle fractures. The “Expert“group also needed less time for the approach (p value 0,008) in case of distal radius fractures.Unexpected events were more often observed in the intervention group (5,5 vs 3,7 %). ConclusionsA surgery supporting computer system might be a good tool for detecting and optimizing workflows in the operation room and for improving and analyzing the training of residents and surgical assistants.In addition, it offers the opportunity to document intraoperative complications. However, a saving of time wasn't observed in this study. Further investigations with bigger number of cases and a longer follow-up are necessary to proof these findings statistically.

Implementation of a health system intervention to reduce time from presentation to surgical intervention for pediatric testicular torsion

Testicular salvage rates for torsion are time-dependent1. Door to detorsion time has been identified as an independent testicular survival factor2. We describe an initiative to reduce door to incision (DTI) time for pediatric testicular torsion. An institutional multidisciplinary quality improvement initiative with a primary outcome of reducing DTI time for pediatric testicular torsion was developed with multidisciplinary stakeholders. Several process and balancing measures were used as secondary outcomes to help interpret and verify the observed change in DTI time. Interventions were implemented in cycles. Initial interventions standardized assessment of suspected torsion by Emergency Medicine utilizing a validated scoring system. A threshold Testicular Workup for Ischemia and Suspected Torsion (TWIST) score led to parallel notification of essential services for rapid assessment and case prioritization3. Subsequently, bedside ultrasound in the Emergency Department was implemented. Progress was tracked in a live dashboard and analyzed with X-mR process control charts and Nelson rules. These tools are used in quality improvement and process control to demonstrate the significance of changes as they are being implemented, prior to when traditional hypothesis testing would be able to do so. We aimed to increase the proportion of cases with DTI times under 4h from 64% to >90% within one year. We observed 22 torsion cases prior to and 62 following initial implementation. The percentage of cases with DTI times under 4h improved from 64% to 95%. At week 29, a shift identified a significant change on the X chart, with reduction in mean DTI time from 221 to 147min. At the same time, a shift on the mR chart identified reduction in patient-to-patient variation. Mean time from arrival to Urology evaluation decreased from 140 to 56min, mean time from arrival to scrotal ultrasound decreased from 70 to 36min, and mean time from scrotal ultrasound to surgical incision decreased from 128 to 80min. These improvements highlight the two key successes of our project: application of the TWIST score and bedside ultrasound for rapid assessment of suspected testicular torsions, and parallel processing of the evaluation and management. Implementation of a protocol for pediatric testicular torsion increased the proportion of cases with DTI time <4h to 95%, decreased mean DTI time, and decreased variation. Our protocol provides a model to improve timeliness of care in treating pediatric testicular torsion.

A novel robot-assisted knee arthroplasty system (ROSA) and 1-year outcome: A single center experience.

Total knee arthroplasty is a successful procedure in the treatment of knee osteoarthritis. Searches in surgical technique have focused surgeons in particular on implant alignment. For this purpose, the use of robot-assisted total knee arthroplasty has become increasingly common in the last 10 years. A total of 46 patients (66 knees) who were operated for knee osteoarthritis with Robotic Surgical Assistant (ROSA, Zimmer-Biomet, Warshaw, Indiana, USA) between 2021 and 2023 were included in the study. Preoperative planning and intraoperative incision time, total surgical time, range of motion and follow-up time recorded. Oxford knee scores and knee society scores (KSS) of the patients were compared before and after surgery. At the last follow-up Forgotten Joint Score and the sagittal and coronal plane alignments were evaluated. Preoperative mean Oxford score of the right knee of the patients was 18.5 ± 3.2, post-surgery mean Oxford score progressed to 43.5 ± 2.2. While the preoperative left knee Oxford score of the patients was 16.9 ± 2.3, the mean left knee Oxford score improved to 43.4 ± 2.2 postoperatively. The mean KSS score of the patients' right knee preoperatively was 49.7 ± 3.5, and progressed to 89.2 ± 4.7 postoperatively. While the preoperative mean left knee KSS score of the patients was 46.5 ± 4.3, the mean KSS score improved to 89.8 ± 3.2 postoperatively. The mean Forgotten Joint Score of the left knee at the last follow-up of the patients was 77.4 ± 3.8, while the mean Forgotten Joint Score of the right knee was 75.4 ± 5.9. The results of ROSA-supported knee arthroplasty found to be functionally successful.

Anesthésie locale sous contrôle d’un anesthésiste pour l’enclouage des fractures du fémur proximal

IntroductionProximal femur fractures have high rates of morbidity, mortality, and perioperative complications. Limiting anesthesia, especially in the elderly population, is a priority from a medical perspective. The goal of the current study is to present a technique of using local anesthetic with monitored anesthesia care (MAC) for the fixation of intertrochanteric (IT) femur fractures with cephalomedullary nailing (CMN), provide early clinical results in a small series of patients, and evaluate the safety, efficiency, and anesthetic efficacy of our technique. HypothesisThe use of only local anesthetic with MAC for the fixation of IT fractures is safe and leads to decreased operative times when compared to spinal and general anesthesia. Materials and methodsPatients undergoing cephalomedullary nailing (CMN) with a long nail for intertrochanteric (IT) femur fractures by a single surgeon from January 2020 to June 2021 were identified retrospectively from a prospectively-collected patient registry. Patient demographics, operative time, length of hospital stay, perioperative medication use, and complications were collected. Analysis of variance, Chi-squared, linear regression, and two-sampled t-tests were performed to analyze potential differences between the local anesthesia group and the general or spinal anesthesia group. ResultsThirty-seven patients were identified. Eleven patients underwent CMN using local anesthesia with MAC, 11 using spinal anesthesia, and 15 using general anesthesia. The local anesthesia group demonstrated significantly lower operating room times and anesthesia induction to incision time compared to other anesthesia techniques. The local anesthesia group also trended towards less need for vasopressors during surgery and less postoperative delirium. No differences were identified in intraoperative narcotic use, complications, patient mortality, or hospital readmissions. ConclusionsLocal anesthesia with MAC for the treatment of IT fractures with CMN was associated with decreased operating room times and had similar complication rates including blood transfusions, readmissions, and mortalities, when compared to spinal and general anesthesia. Level of evidenceIII, therapeutic.

The Outcomes of Using Scalpel and Electrosurgery Methods for Anterior Abdominal Wall Incision During Cesarean Section

Background: There are different ways to make a surgical incision. The most widely used ones are the use of scalpel and electrosurgery. Each of these methods has advantages and disadvantages that affect its use. Objectives: This study aimed to compare scalpel and electrosurgery methods in cutting the anterior abdominal wall during Cesarean section. Methods: This double-blind clinical trial manner was conducted by permuted block randomization. The participants were placed in two groups. In the scalpel group, incisions were made with a scalpel, and in the electrosurgery group, incisions were made with an electrosurgical pencil. This clinical trial was conducted on 86 pregnant women who were candidates for Cesarean section with spinal anesthesia. The inclusion criteria were an age range of 18 - 45 years, gestational age of 37 - 41 weeks, Pfannenstiel skin incision, and willingness to participate. The exclusion criteria were emergency Cesarean section, vertical skin incisions, incomplete medical files, chronic skin diseases, allergy to antibiotics, consuming anticoagulants, cardiovascular and pulmonary problems, and underlying diseases. Results: There was no significant difference between the two groups in terms of intraoperative bleeding, newborn Apgar score, postoperative pain, and wound complications. However, the duration of surgery (P = 0.012), incision time (P = 0.049), and hemodynamic status showed a significant difference (P &lt; 0.05). Conclusions: The use of electrosurgery to make a surgical incision does not pose a risk to the patient if safety points are followed.

Magnitude and timing of transient incision resulting from large‐scale drainage capture, Sutlej River, Northwest Himalaya

AbstractFew studies have constrained the magnitudes and timescales associated with large‐scale drainage captures (areas &gt;103 km2), even though these constraints are crucial to reconstruct sediment budgets, assess the potential for drainage reorganization to be preserved in the rock record, and determine the extent to which environmental signals (i.e., structures, composition and fossil assemblages within sedimentary rocks that are influenced by sediment supply and transport) are representative of conditions during deposition. In this work, we characterize the Pleistocene capture of the Zhada Basin, an ~23 000 km2 extensional basin in southern Tibet, by the Sutlej River, a prominent tributary to the Indus River. We quantify the magnitudes and timescales of capture‐driven erosion using knickpoint celerity modelling, paleotopographic reconstructions, 10Be‐derived denudation rates, and topographic analyses of drainage divides. We find that capture has removed 2010 ± 400 km3 of sediment from the Zhada Basin, increasing sediment supply to the Sutlej network by 17%–29% since 735 ± 269 ka. This work represents a crucial step towards reconstructing the Pleistocene sediment budget of the Indus sedimentary system and identifying potential impacts from sediment redistribution. We also identify several plausible tectonic or autogenic mechanisms that may have facilitated capture of the Zhada Basin, including: (1) preferential erosion of weak lithologies along active faults, (2) headward erosion in response to prior capture of the Spiti River and (3) headward erosion generated by breaching of a structural culmination downstream (the Kullu‐Rampur Window). This provides a framework to assess the mechanistic links between arc‐parallel extension, large‐scale drainage capture, landscape evolution and orogenic wedge deformation.

Machine Learning for the Prediction of Procedural Case Durations Developed Using a Large Multicenter Database: Algorithm Development and Validation Study.

Accurate projections of procedural case durations are complex but critical to the planning of perioperative staffing, operating room resources, and patient communication. Nonlinear prediction models using machine learning methods may provide opportunities for hospitals to improve upon current estimates of procedure duration. The aim of this study was to determine whether a machine learning algorithm scalable across multiple centers could make estimations of case duration within a tolerance limit because there are substantial resources required for operating room functioning that relate to case duration. Deep learning, gradient boosting, and ensemble machine learning models were generated using perioperative data available at 3 distinct time points: the time of scheduling, the time of patient arrival to the operating or procedure room (primary model), and the time of surgical incision or procedure start. The primary outcome was procedure duration, defined by the time between the arrival and the departure of the patient from the procedure room. Model performance was assessed by mean absolute error (MAE), the proportion of predictions falling within 20% of the actual duration, and other standard metrics. Performance was compared with a baseline method of historical means within a linear regression model. Model features driving predictions were assessed using Shapley additive explanations values and permutation feature importance. A total of 1,177,893 procedures from 13 academic and private hospitals between 2016 and 2019 were used. Across all procedures, the median procedure duration was 94 (IQR 50-167) minutes. In estimating the procedure duration, the gradient boosting machine was the best-performing model, demonstrating an MAE of 34 (SD 47) minutes, with 46% of the predictions falling within 20% of the actual duration in the test data set. This represented a statistically and clinically significant improvement in predictions compared with a baseline linear regression model (MAE 43 min; P<.001; 39% of the predictions falling within 20% of the actual duration). The most important features in model training were historical procedure duration by surgeon, the word "free" within the procedure text, and the time of day. Nonlinear models using machine learning techniques may be used to generate high-performing, automatable, explainable, and scalable prediction models for procedure duration.

Timing and drivers of exhumation and sedimentation in the eastern Peruvian Andes: Insights from thermokinematic modelling

This study assesses the impact of fold-thrust belt driven deformation on the topographic evolution, bedrock exhumation and basin formation in the southeastern Peruvian Andes. We do this through a flexural and thermokinematically modelled balanced cross-section. In addition, published thermochronology samples from low-elevation (river canyons) and high-elevation (interfluves) and Cenozoic sedimentary basin datasets along the balanced cross-section were used to evaluate the age, location, and geometry of fault-driven uplift, as well as potential relationships to the timing of ∼2 km of canyon incision. The integrated structural, thermochronologic, and basin data were used to test the sensitivity of model results to various shortening rates and durations, a range of thermophysical parameters, and different magnitudes and timing of canyon incision. Results indicate that young apatite (U-Th)/He (AHe) canyon samples from ∼2 km in elevation or lower are consistent with river incision occurring between ∼8–2 Ma and are independent of the timing of ramp-driven uplift and accompanying erosion. In contrast, replicating the young AHe canyon samples located at >2.7 km elevation requires ongoing ramp-driven uplift. Replicating older interfluve cooling ages concurrent with young canyon ages necessitates slow shortening rates (0.25–0.6 mm/y) from ∼10 Ma to Present, potentially reflecting a decrease in upper plate compression during slab steepening. The best-fit model that reproduces basin ages and depositional contacts requires a background shortening rate of 3–4 mm/y with a marked decrease in rates to ≤0.5 mm/y at ∼10 Ma. Canyon incision occurred during this period of slow shortening, potentially enhanced by Pliocene climate change.

Rethinking Variability in Bedrock Rivers: Sensitivity of Hillslope Sediment Supply to Precipitation Events Modulates Bedrock Incision During Floods

AbstractBedrock rivers are the pacesetters of landscape evolution in uplifting fluvial landscapes. Water discharge variability and sediment transport are important factors influencing bedrock river processes. However, little work has focused on the sensitivity of hillslope sediment supply to precipitation events and its implications on river evolution in tectonically active landscapes. We model the temporal variability of water discharge and the sensitivity of sediment supply to precipitation events as rivers evolve to equilibrium over 106 model years. We explore how coupling sediment supply sensitivity with discharge variability influences rates and timing of river incision across climate regimes. We find that sediment supply sensitivity strongly impacts which water discharge events are the most important in driving river incision and modulates channel morphology. High sediment supply sensitivity focuses sediment delivery into the largest river discharge events, decreasing rates of bedrock incision during floods by orders of magnitude as rivers are inundated with new sediment that buries bedrock. The results show that the use of river incision models in which incision rates increase monotonically with increasing river discharge may not accurately capture bedrock river dynamics in all landscapes, particularly in steep landslide prone landscapes. From our modeling results, we hypothesize the presence of an upper discharge threshold for river incision at which storms transition from being incisional to depositional. Our work illustrates that sediment supply sensitivity must be accounted for to predict river evolution in dynamic landscapes. Our results have important implications for interpreting and predicting climatic and tectonic controls on landscape morphology and evolution.

Exhumation and incision of the eastern Central Andes, southern Peru: Low-temperature thermochronology observations

Quantifying the impacts of past changes in tectonics or climate on mountain topography has proven challenging. The incision of the eastern Central Andean Plateau has been interpreted as both a result of deformation-related uplift and erosion and climate-driven erosion. Here, we contribute >100 new apatite and zircon (U-Th)/He and fission-track dates from 51 new and eight previous bedrock samples. These samples were combined with previous thermochronometer data from three ∼190-km-long and ∼200-km-apart across-strike transects along the eastern margin of the Andean Plateau in southern Peru. We discuss age-distance, age-elevation, and inverse thermal history model results along these transects to constrain the timing and extent of recent canyon incision compared to the region's long-term (∼40 Myrs) exhumation history. Results indicate that, along the plateau flank, long-term, deformation-related exhumation is superimposed by a regional, synchronous canyon incision-related signal since ∼4–3 Ma. This incision is traceable from at least the Abancay Deflection in southern Peru to southern Bolivia along the eastern Central Andes. Based on the regional and synchronous character of canyon incision across areas with different deformation histories and exhumation magnitude, we suggest that paleoclimate change was a significant contributor to incision. However, structural processes resulting in surface uplift, erosion, and exhumation continued post-mid Miocene and contributed to the observed exhumation magnitude.

70 Decision to Incision Time: Can the Principle Be Applied to Emergency General Surgery in Order to Tackle Delays in Patient Care?

Abstract Aim General surgical patients who require emergency surgery should have timely access to operating theatre to ensure optimal outcomes. It is important to evaluate delays in order to identify contributing elements and help to improve standards of surgical care. The decision to incision time interval is a benchmark used in obstetric practice. This study aimed to assess the use of this time interval in the emergency general surgical setting to consider whether the principle may be translatable. Method Prospective data were collected on patients undergoing emergency general surgery in a tertiary care centre over four weeks. Data were extracted from patient notes and anonymised for statistical analysis. Results No statistically significant associations were found with the studied variables and decision to incision time. However, this study identified clear delays, with 66% of emergency operations taking place after target time assigned by NCEPOD classification. It identified trends in varying decision to incision time in patient and procedure type. It also identified issues with documentation and an association between longer decision to incision time and post-operative length of stay. Conclusions This study highlights important delays in emergency general surgery. Decision to incision time reveals important trends and, with larger sample sizes, may identify areas which hinder time-sensitive procedures. This study recommends that decision time could be more formally incorporated into surgical documentation to better monitor delays. The findings of this study could inform future research, which is required to determine the true potential of using decision to incision time interval in emergency general surgery.