Operating Theatre Time Research Articles

Gynecologic oncology robot-assisted surgery in octogenarians: Impact of age on hospital stay.

To compare postoperative stay in octogenarians and younger patients undergoing gynecologic oncology robot-assisted surgery. A retrospective review of robot-assisted surgery in Gynecological Oncology division during 2019-2022. We included all consecutive cases. Octogenarians (age ≥80 years) and younger patients were investigated by univariable analysis for characteristics and outcome. A total of 816 robot-assisted surgeries were performed, 426 (52.2%) endometrial cancer, 159 (19.5%) ovarian cancer, 27 (3.3%) cervical cancer, 35 (4.3%) endometrial intraepithelial neoplasia, and in 169 (20.7%) the final pathology was benign. There were 60 (7.4%) octogenarians and 756 (92.6%) younger patients. The proportion of patients with an American Society of Anesthesiology score greater than 2 was higher among octogenarians (66.7% vs 32.0%, P < 0.001). The median console time, surgical time, and total operation theater time were similar between groups (P = 0.303, P = 0.643 and P = 0.688, respectively). Conversion rate did not differ between groups (0.4% among younger patients vs 0% in octogenarians, P > 0.99). The median length of stay in the recovery room was similar in both groups (median 170 min, interquartile range [IQR] 125-225 min vs 170 min, IQR 128-240 min in octogenarians, P = 0.731). Length of hospital stay was similar in both age groups; median 1 day (IQR 1-1) among octogenarians versus 1 (0-1) in younger patients (P = 0.136). Octogenarians undergoing robotic surgery have no increased risk of length of stay or conversion to laparotomy compared with younger patients.

Stabilised Hyaluronic Acid (sHA) gel as a novel marker for breast cancer tumour bed cavity: Surgical feasibility

IntroductionConsistent delineation of the breast conserving surgery (BCS) tumour bed (TB) for breast cancer remains a challenge for radiation oncologists. Accurate delineation allows for better local control and reduces toxicity when planning partial breast or TB boost radiation therapy (RT). MethodsIn the operating theatre (OT) breast surgeons inserted stabilised hyaluronic acid (sHA) gel as small drops approximately one cm into the walls surrounding the resection cavity. Surgical feasibility was determined by the rate of successful sHA gel insertion procedure, the ease of insertion as rated by surgeons, the time required for insertion procedure, the quantity used, and any adverse events (AE) relating to sHA gel insertion. ResultsThirty-five patients were enrolled. All patients underwent sHA gel insertion successfully. The procedure added a median of 2.8 min to the OT time and was rated as ‘easy’ in 89 % of patients. There were no immediate AE in OT. Five (14 %) patients experienced a grade 2 or higher AE. Three of the five patients were prescribed oral antibiotics for breast infection. Two of the five patients experienced a grade 3 AE – haematoma which required evacuation in OT day 1 post-BCS, and infected seroma which required drainage and washout in OT 2 months post-BCS. All five patients recovered and underwent the planned adjuvant therapies for their BC. The AE data reflects common risks with standard BCS and are not clearly attributed to sHA gel insertion alone. ConclusionWe show that sHA gel is surgically feasible as a marker to help define the TB cavity for post-BCS adjuvant MRI-based RT planning.

Effects of a management team training intervention on the compliance with a surgical site infection bundle: a before–after study in operating theatres in the Netherlands

ObjectivesTo assess the effects of a quality improvement (QI) team training intervention, by measuring the intervention fidelity and the compliance with a surgical site infection (SSI) bundle in the operating...

MP59-01 A PROSPECTIVE MULTICENTER COMPARISON BETWEEN HOLMIUM LASER ENUCLEATION OFTHE PROSTATE (HOLEP) AND AQUABEAM ROBOTIC SYSTEM FOR THE TREATMENT OF BENIGNPROSTATIC HYPERPLASIA

You have accessJournal of UrologyCME1 Apr 2023MP59-01 A PROSPECTIVE MULTICENTER COMPARISON BETWEEN HOLMIUM LASER ENUCLEATION OFTHE PROSTATE (HOLEP) AND AQUABEAM ROBOTIC SYSTEM FOR THE TREATMENT OF BENIGNPROSTATIC HYPERPLASIA Javier Romero Otero, Juan Justo Quintas, Raquel Sopeña Sutil, Borja García Gómez, Ricardo Brime Menendez, Javier Amalio Feltes Ochoa, David Saenz Calzada, Gino Marcelo Espinales Catro, Laura Avilleira García, Elena Peña Vallejo, Cristina Calzas Montalvo, Alfredo Rodríguez Antolín, and Esther Garcia Rojo Javier Romero OteroJavier Romero Otero More articles by this author , Juan Justo QuintasJuan Justo Quintas More articles by this author , Raquel Sopeña SutilRaquel Sopeña Sutil More articles by this author , Borja García GómezBorja García Gómez More articles by this author , Ricardo Brime MenendezRicardo Brime Menendez More articles by this author , Javier Amalio Feltes OchoaJavier Amalio Feltes Ochoa More articles by this author , David Saenz CalzadaDavid Saenz Calzada More articles by this author , Gino Marcelo Espinales CatroGino Marcelo Espinales Catro More articles by this author , Laura Avilleira GarcíaLaura Avilleira García More articles by this author , Elena Peña VallejoElena Peña Vallejo More articles by this author , Cristina Calzas MontalvoCristina Calzas Montalvo More articles by this author , Alfredo Rodríguez AntolínAlfredo Rodríguez Antolín More articles by this author , and Esther Garcia RojoEsther Garcia Rojo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostatic enucleation is considered the gold standard for the surgical treatment of benign prostatic hyperplasia(BPH). Emerging minimally invasive technologies aim to maintain functional results whilst decreasing adverseevents. Aquablation is a novel heat-free therapy using a high-velocity waterjet and real-time ultrasound imaging with robotic assistance for removal of prostate tissue. Our objective is to compare for the first time the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) and Aquablation for the surgical treatment of BPH. METHODS: Prospective comparative non-randomized multicenter study of 100 consecutive patients treated with HoLEP or Aquabeam system. HoLEP was performed by 3 expert surgeons and a standard Aquablation was performed with the AquaBeam system by 2 surgeons. Inclusion criteria: patients with moderate/severe symptoms due to BPH. Exclusion criteria: previous surgical treatment for BPH, concomitant urethral stenosis, bladder tumor, or lithiasis and prostates >120cc. The data were prospectively collected. A descriptive analysis was performed and data onthe efficacy and safety of both techniques were compared. RESULTS: The groups are comparable (p>0.05) in prostate size; mean HoLEP vs Aquabeam; 78.95 vs 77.10cc, preoperative IPSS (24.26 vs 22.68), Q max (8.44 vs 9.83) and IIEF15 (41.10 vs 58.15), as well as in the rest preoperative variables (age, personal history, PSA, ASA risk and ejaculation function). Treatment time was longer in the HoLEP group with a mean of 23 minutes for enucleation vs. 5.99 minutes in the Aquabeam group (p<0.05). However, no statistically significant differences in total operating theatre time (53 vs 60 minutes). No intraoperative complications. More significant haematic loss (haemoglobin drop) in the Aquabeam group but none of the patients required a transfusion. As for the perioperative outcomes: no differences were observed between the two groups in bladder catheterization time: 30.53 vs 46.91 hours and hospitalization time 1.4 vs 1.74 days. No differences in rehospitalization, emergency room visits, recatheterization, or infection. At the 6-month follow-up, no statistically significant differences were found in Q-max, BOO, IPSS, complication rates or incontinence. On the other hand, statistically significant differences were found in prostate volume (16.86 vs 42.43 p=0.012) and PSA(0.51 vs 4.2 p<0.01). All patients with Aquabeam retain anterograde ejaculation, while only one patient in the HoLEP group preserves it. CONCLUSIONS: The Aquabeam System appears to be a safe technique that provides comparable early functional and perioperative results to HoLEP with a similar complication rate. Advantages of this technique include reduced resection time as well as the possibility of preserving sexual function. Source of Funding: no © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e806 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Javier Romero Otero More articles by this author Juan Justo Quintas More articles by this author Raquel Sopeña Sutil More articles by this author Borja García Gómez More articles by this author Ricardo Brime Menendez More articles by this author Javier Amalio Feltes Ochoa More articles by this author David Saenz Calzada More articles by this author Gino Marcelo Espinales Catro More articles by this author Laura Avilleira García More articles by this author Elena Peña Vallejo More articles by this author Cristina Calzas Montalvo More articles by this author Alfredo Rodríguez Antolín More articles by this author Esther Garcia Rojo More articles by this author Expand All Advertisement PDF downloadLoading ...

Designing cranial fixture shapes and topologies for optimizing PEEK implant thickness in cranioplasty

Cranial defects are often caused by trauma, diseases or malignancy. To repair such defects, skull reconstruction or cranial implants are required for protecting intracranial structures and normalizing cerebral hemodynamics. To relieve Intracranial Pressure (ICP) surgeons restore cranial defects using the preserved bone of a patient. In case of non-availability of natural bone cranial implants are fabricated using biocompatible materials including Titanium Alloys (Ti-6Al-4V) and polyether-ether-ketone (PEEK). Patient-specific implants (PSI) manufactured using 3D printing, 3D imaging technologies and 3D modeling software, are preferred over conventional manufacturing methods. During cranial fixation bone fragments, grafts and bone flaps are fixed to the cranium to offer stable closure in surgery. Effective attachment of an implant to a defective skull is influenced by the joints and fixture arrangements at the interface. These fixtures can have various designs, materials and joining procedures. PEEK behaves similarly to bone during deformation, which means it is receptive to titanium fixations and supports soft tissue adhesion due to its inert nature. This study considers PEEK as an implant material for reconstructing a bone-defected skull with Ti-6Al-4V fixtures attached at the skull-implant interface. This work compares Ti-6Al-4V fixture shapes (Linear, Square and Burrhole) with different orientation angles and topologies (‘+’ and ‘X’) attached to PEEK cranial implants of variable thicknesses (1–7 mm). Using Finite Element Method (FEM)/Finite Element Analysis (FEA), von Mises stress analysis was analyzed to identify the implant thicknesses that would bear an external load of 1780 N and ICP of 15 mmHg without failure. With a yielding limit of 100 MPa for PEEK, all proposed design arrangements for the fixture plates in the skull-implant assembly were well within these limits exhibiting a maximum von Mises stress of 51.985 MPa for the least implant thickness of 1 mm and weight 12.90 g. Considering all the designs, a Linear Fixture shape with 45° angular orientations placed in ‘X’ topology exhibited least stress of 18.477 MPa and was therefore proposed as the most optimized design for the skull-implant fixture assembly. Selection of an optimized design arrangement is also dependent upon other clinical factors, such as number of screws used, the Additive Manufacturing (AM) technique for fabricating/cutting of precise slots within the implant. The skull and flexibility of the fixture plates are also considered in relation to the required operating theatre time and skills of the surgical team.

Healthcare resource use and costs related to surgical infections of tibial fractures in a Spanish cohort

Surgical site infection constitutes a serious complication in the healing process of bone fractures and has been associated with increases in medical resource use and healthcare costs. This study evaluates the economic impact of surgical site infection in tibial fractures in a Spanish cohort. It is a retrospective, single-centre, comparative cohort study of patients with tibial fractures with longitudinal follow-up for up to 18 months post-surgery. Included patients (n = 325) were adults, with tibial fracture, either isolated or polyfracture, or polytrauma with an Injury Severity Score &gt;15. Patients had been surgically treated within 30 days of the tibial fracture by external or internal fixation, or external followed by internal fixation. Most patients (84.9%) had an American Society of Anaesthesiology score of 1-2. 20% of the patients had one open tibial fracture, 12.3% had polytrauma, and 20% had multiple fractures. Most patients were treated with a nail (41.8%) or a plate (33.8%). 56 patients (17.2%) developed surgical site infection. Patients with infection had significantly higher hospital length of stay (34.9 vs 12.0 days; p&lt;0.001; +191%), readmissions (1.21 vs 0.25; p&lt;0.001; +380%) and mean operating theatre time (499 vs 219 min; p&lt;0.001; +128%) than patients without infection. Mean length of stay in intensive care did not significantly increase with infection (2.8 vs 1.7 days; p = 0.25). Total in-hospital costs for patients with infection increased from €7,607 to €17,538 (p&lt;0.001; +131%). Overall, infections were associated with significantly increased healthcare resource use and costs. Preventive strategies to avoid infections could lead to substantial cost savings.

Audit of operation theater time utilization with perspective to optimize turnaround times and theater output.

Operation theater (OT) complex is an important area for a hospital as it needs expensive infrastructure, disposable, and reusable resources and a multidisciplinary highly qualified and efficient team, the metrics of which are key in generating revenue, and improved productivity. The efficient utilization of OT ensures maximum output in view of the investment of highly qualified doctors, equipment, and outcomes. Our study aimed to evaluate the utilization of OT functioning stepwise, reasons for delays, case cancellations, and areas of improvement if any. This prospective observational study was planned in three phases; in phase 1 audit of OT functioning was carried out for 1 month and based on data analysis recommendations were given for improvement. In phase 2, the recommendations would be implemented over 3 months and in phase 3 re-audit will be carried out for 1 month. Data analysis was done on IBM SPSS version 26 software. Descriptive statistics measures were calculated by the mean and standard deviation. The total available resource time was 52920 min and the total time utilized was 37740 min. Overall, raw utilization was 71.31%. OT was started late 63.50% times. Case cancellation occurred on 8.99% occasions. We conclude that utilization of operating room time can be maximized by proper planning and realistic scheduling of elective lists, communication among team members, and resource management. Audit of OT utilization is an important tool to identify problem areas and formulate protocols accordingly.

Safety and efficacy of anterior intercostal artery perforator flaps in oncoplastic breast reconstruction.

Partial breast reconstruction based on the anterior intercostal artery perforators (AICAP) has been suggested to avoid the unsightly 'bird's beak' deformity for lower pole breast cancers. The aims of this study were to evaluate the initial clinical experience of AICAP flaps in terms of safety and efficacy in oncoplastic breast reconstruction. Between October 2013 and April 2020, AICAP flaps were offered to 30 patients with lower pole breast cancers. Hand-held Acoustic Doppler assessments were undertaken to confirm adequate perforators. Surgical results were evaluated in terms of safety and efficacy. Patients were invited to complete sections of the Breast-Q questionnaire at least 12 months postoperatively to assess patient satisfaction in terms of cosmetic outcome, physical and psychosocial wellbeing. Median operating theatre time for AICAP flap harvesting and positioning was 20 min (range 15-28 min). The median weight of resected breast specimens was 41 g (range 10-127 g). Total tumour size ranged from 7 to 35 mm (median 16 mm; three cases exhibited multifocal disease). Clear radial resection margins were achieved in 29 cases (96.7%). The median post-operative stay was two days (range 2-3 days). There were two postoperative complications comprising delayed wound healing/fat necrosis, which resolved with monitoring and inadine dressings. Based on the Breast-Q results, patients reported high levels of satisfaction with the physical appearance of their reconstructed breast, psychosocial and physical wellbeing. AICAP flaps appear to be safe in restoring breast contour after wide excision of lower pole breast cancers, with high levels of patient satisfaction reported postoperatively.

Volcanic disruption: the impact of Whakaari White Island on the provision of elective surgical care in Counties Manukau.

On 9 December 2019, Whakaari White Island erupted while 47 people were on the island. Thirty-one people were subsequently hospitalized. Fourteen volcanic burn victims were managed at the National Burns Centre at Middlemore Hospital. Between December 2019 and March 2020 these patients required 124 procedures in theatre, using 23 709 operative minutes. Elective surgical lists were cancelled to fulfil this demand for acute operating theatre time and theatre staff. To quantify the elective surgical resource lost in the aftermath of the Whakaari White Island eruption by surgical specialty. A data set listing all surgical procedures undertaken within Counties Manukau District Health Board during the period 1 December 2019-1 March 2020 and the corresponding months from the preceding 3 years was analysed. Sum operating time and procedures post-Whakaari were compared with the average of the prior 3 years to quantify loss in resource. In the 3 months post-Whakaari, 698 fewer elective operations were completed across all surgical specialties than the average of the previous 3 years, a decrease of 26.3%. All major surgical specialties except urology showed an absolute decrease in elective procedures completed. The most significant decrease was the 59.1% (533 procedures) loss in plastic surgery elective procedures, with no sign of recovery by March 2021. The plastic surgery department was the worst affected by the Whakaari disaster. Overall elective surgical delivery within Counties Manukau was substantially impacted, and would not yet recover by the time of the national COVID-19 lockdown in March 2020.

310 Cost Savings Through Utilisation Of Procedural Clinics Over Operating Theatres for Skin Lesion Excisions

Abstract Aim Skin lesion excisions make up a significant proportion of procedures performed by General Surgical teams. A large proportion are performed under local anaesthetic (LA) alone and are frequently performed in a main operating theatre (OT) but would be amenable to been performed in a minor procedures clinic (MPC) which could represent significant savings for excision of lesions in terms of money and better utilisation of OT. The purpose of this study is to evaluate the proportion of skin lesions currently excised under LA in OT that would be amenable to been performed in MPC and calculating the cost saving associated with this in terms of dollars and time in OT. Method A retrospective audit was performed of all skin lesion excised in OT at 2 regional hospitals in Queensland between October 2019 and October 2020. Data was recorded for the type of anaesthetic used, type of lesion excised and total time each patient spent in the OT. Cost per minute of both OT and MPC time were estimated using standard costs. Results A total of 229 patients had skin lesions excised in an OT in this period. Of these, 102 (44.5%) of them were excised under LA alone and used 4930 minutes of OT time. The dollar saving of performing these procedures in a MPC over OT is estimated to be $147,874.00 (approximately 71% less). Conclusions Utilising MPC over an OT for excision of skin lesions under LA represents a significant dollar cost saving and opportunity cost saving.

Bacterial arthritis of native joints can be successfully managed with needle arthroscopy

PurposeTo assess the feasibility of needle arthroscopy for management of suspected bacterial arthritis in native joints.MethodsDuring a pilot period, patients presenting with symptoms suggestive of native joint bacterial arthritis were eligible for initial management with needle arthroscopy. Procedures were performed in the operating theatre or at the patient bedside in the emergency department or inpatient ward. As our primary outcome measure, it was assessed whether needle arthroscopic lavage resulted in a clear joint. In addition, the need for conversion to standard arthroscopy or arthrotomy, the need for conversion from local to general anaesthesia, complications and the need for additional surgical intervention at follow-up during admission were recorded.ResultsEleven joints in 10 patients (four males, age range 35 – 77) were managed with needle arthroscopy. Needle arthroscopic lavage resulted in a clear joint in all cases. Conversion to standard arthroscopy or arthrotomy was not needed. Seven procedures were performed at the patient bedside using local anaesthesia. These procedures were well tolerated and conversion to general or spinal anaesthesia was not required. There were no procedure complications. One patient received multiple needle arthroscopic lavages. No further surgical interventions beside the initial needle arthroscopic lavage were required for successful management in other cases.ConclusionsNeedle arthroscopy can be a feasible tool in the initial management of complaints suggestive for native joint bacterial arthritis, providing an effective, quick and well-tolerable intervention in the operating theatre or at the patient bedside, with the potential to relief health systems from need for scarce operating theatre time.

Direct anterior approach has short-term functional benefit and higher resource requirements compared with the posterior approach in primary total hip arthroplasty : a meta-analysis of functional outcomes and cost.

It has been suggested that the direct anterior approach (DAA) should be used for total hip arthroplasty (THA) instead of the posterior approach (PA) for better early functional outcomes. We conducted a value-based analysis of the functional outcome and associated perioperative costs, to determine which surgical approach gives the better short-term outcomes and lower costs. This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and the Cochrane Handbook. Several online databases were searched. Non-stratified and stratified meta-analyses were conducted to test the confounding biases in the studies which were included. The mean cost and probability were used to determine the added costs of perioperative services. The DAA group had significantly longer operating times (p < 0.001), reduced length of hospital stay by a mean of 13.4 hours (95% confidence interval (CI) 9.12 to 18; p < 0.001), and greater blood loss (p = 0.030). The DAA group had significantly better functional outcome at three (p < 0.001) and six weeks (p = 0.006) postoperatively according to the Harris Hip Score (HHS). However, there was no significant difference between the groups for the HHS at six to eight weeks (p = 0.230), 12 weeks (p = 0.470), six months (p = 0.740), and one year (p = 0.610), the 12-Item Short Form Survey (SF-12) physical score at six weeks (p = 0.580) and one year (p = 0.360), SF-12 mental score at six weeks (p = 0.170) and one year (p = 0.960), and University of California and Los Angeles (UCLA) activity scale at 12 weeks (p = 0.250). The mean non-stratified and stratified difference in costs for the operating theatre time and blood transfusion were $587.57 (95% CI 263.83 to 1,010.29) to $887.04 (95% CI 574.20 to 1,298.88) and $248.38 (95% CI 1,003.40 to 1,539.90) to $1,162.41 (95% CI 645.78 to 7,441.30), respectively, more for the DAA group. However, the mean differences in costs for the time in hospital were $218.23 and $192.05, respectively, less for the DAA group. The use of the DAA, rather than the PA, in THA has earlier benefits for function and pain. However, these are short-lasting, with no significant differences seen at later intervals. In addition the limited benefits were obtained with higher cumulative costs for DAA. Cite this article: Bone Joint J2021;103-B(6):1078-1087.

The costing of operating theatre time in a secondary-level state sector hospital: A quantitative observational study.

There is no established costing model for operating theatres (OTs) in South Africa (SA), yet both health sectors have existing charges for OT time: in the state sector, Uniform Patient Fee Schedule (UPFS) rates, and in the private sector, rands per minute (ZAR/min) rates. Understanding the cost of providing the separate components of a health service is important for planning and funding purposes. To develop a costing model that would allow calculation of the ZAR/min cost of OT time. To determine the actual costs, in order to establish the comparable costs that would be included in the ZAR/min charges for OTs in the private health sector. The OTs in a secondary-level, state sector hospital in Cape Town were used in this quantitative observational study to develop a top-down costing model for OTs in SA. The inclusive costing model was developed in a consultative process with professionals, managers and experts from the state and private sectors. The model was then populated with costs for the month of August 2018. Costs were considered in the categories of full costs, shared costs, and capital or annualised costs. Owing to uncertainty in costing of OTs, two models - with different annualisation times assigned to the capital costs - were developed to demonstrate the difference. For shared costs, correction factors were determined using either an activity-based (workload) factor or a more generic estimation of workload using theatre nursing staff as a percentage of total hospital nursing staff.To determine a ZAR/min cost of creating a minute of available theatre time, all the annual costs were divided by minutes that the OTs are explicitly available, each year, to provide patient care. The model was then populated with costs using the appropriate correction factors. The longer annualisation model costed OT time at ZAR31.46 per minute, and the shorter annualisation model at ZAR33.77 per minute. In both the longer and shorter capital annualisation models, nursing was the largest contributor to costs at 36% and 33%, respectively, followed by construction costs at 9% and 11%, and then OT equipment at 8% and 11%. An inclusive, top-down costing model for OTs in SA was developed. This costing model will support work to develop costing for individual procedures and the appropriate charge for planned and emergency OT time, and to better determine budgeting for OT services. Meaningful critique of the model will improve its fidelity, and is likely to increase its utility, especially as SA moves towards universal health coverage.

The Impact of a Dedicated "Hot List" on the In-Patient Management of Patients With Acute Gallstone-Related Disease.

Background: Index admission laparoscopic cholecystectomy is the standard of care for patients admitted to hospital with symptomatic acute cholecystitis. The same standard applies to patients suffering with mild acute biliary pancreatitis. Operating theatre capacity can be a significant constraint to same admission surgery. This study assesses the impact of dedicated theatre capacity provided by a specialist surgical team on rates of index admission cholecystectomy.Methods: This clinical cohort study compares the management of patients with symptomatic gallstone disease admitted to a tertiary care university teaching hospital over two equal but chronologically separate time periods. The periods were before and after service reconfiguration including a specialist HPB service with dedicated operating theatre time allocation.Results: There was a significant difference in the number of admissions over the two time periods with a greater proportion of patients having index admission surgery in the second time period with correspondingly fewer having more than one admission during this latter time period. In the second time period 43% of patients underwent index admission cholecystectomy compared to 23% in the first (P < 0.001). The duration of surgery was shorter for patients undergoing surgery during the second time period [135 (102–178) min in the first period and in the second period 106 (89–145) min] (P = 0.02).Discussion: This paper shows that the concentration of theatre resources and surgical expertise into regular theatre access for patients undergoing urgent laparoscopic cholecystectomy is an effective and safe model for dealing with acute biliary disease.

Allocation scheduling leads to optimum utilization of operation theater time

BackgroundCancellation of surgeries is a regular phenomenon in any hospital, and reasons may vary from clinical to managerial ones. The aim of the study is to suggest scheduling to address the problem of time over run related cancellations. This is an observational and descriptive study conducted in a tertiary care hospital with ophthalmology facilities. The sample size is calculated with 95% confidence interval using Epi Info 6 from the total surgeries performed in the last 5 years (n = 380). Simple random sampling technique was used. MethodsSurgical time for all types of ophthalmic surgeries (n = 582) was observed. Allocation of listed cases to the available operating rooms (ORs) was carried out using the observed time using LEKIN software. ResultsThe time over-run of 2 h and 6 h was noted for two units, whereas idle OR time was observed in other units. An average idle time of 19% was noted on each day. Reallocation of the cases to the ORs was carried out taking all the planned cases (of both the operating units of the day) as the number of jobs and all the available ORs as parallel machines using LEKIN software. All the planned cases could be accommodated; still, an average of 17% of the total available operation theater (OT) time was found idle on each day. ConclusionsPlanning of cases using procedure time and scheduling on a daily basis using allocation models with simple algorithms can provide optimal utilization of OTs and can address the time over-run and related cancellations.

‘Out of house’ virtual surgical planning for mandible reconstruction after cancer resection: is it oncologically safe?

The purpose of this study was to investigate whether the time delay between ‘out of house’ proprietary virtual surgical planning (OH-VSP) of the mandibular resection for oral cancer and the actual surgery results in compromised margins and oncological disadvantage for the patient. Outcomes of patients who had OH-VSP of their mandibular resection and reconstruction were compared with those of patients who had the same surgery using a conventional non-VSP approach. The groups were similar in patient demographics, tumour stage and size, nodal status, and reconstruction complexity. VSP resulted in a significant reduction in operating time (P<0.01). VSP did not affect bony (P=0.49) or soft tissue (P=0.22) margin status. In summary, VSP reduced the operating theatre time, and despite the time interval between bony resection planning and surgery, there was no compromise to the oncological safety of the operation.

Management of Adnexal Torsion in the Pediatric and Adolescent Population at Western Australia's Single Tertiary Children's Hospital over the Last 10 Years: Retrospective Study

To review our institutional data regarding the management of adnexal torsion (AT) and assess the ovarian conservation rates. Retrospective study. Tertiary children's hospital. Pediatric and adolescent patients with surgically diagnosed AT. Participants (n = 54, mean age 9.80 ± 3.95 years) were identified between June 2010 and May 2019. Surgical management of AT. The primary outcome was to determine the ovarian conservation rates in AT cases. The secondary outcomes were to determine the incidence of AT to total emergency department (ED) presentations, decision to operation theater (OT) time in AT cases, return to OT, histopathology, and follow-up with ultrasound to determine ovarian function. Data were collected on demographic and clinical characteristics. Continuous data were compared with t tests or Kruskal-Wallis tests; categoric data were compared with chi-square tests. A total of 52 (96.29%) patients had ovarian conservation, and 53 (98.14%) had laparoscopic management. The incidence rate for AT cases to total ED presentations for the last 10 years was 9.9 per 100 000, which was based on a Poisson distribution. Presentations to an ED for AT cases have trended upward since 2010. Decision to OT time was statistically significantly shorter in cases with preoperative suspicion of AT than those with intraoperative diagnosis of AT (p = .000). A total of 7 (12.96%) patients returned to OT for suspicion of recurrent torsion. Of these, 5 (9.26%) had confirmed repeat AT. The presence of fever, pain duration, severity of pain, and severity of torsion did not correlate with the follow-up ultrasound findings of ovarian activity. The findings from our study suggest that high ovarian conservation rates are achievable in AT cases. A high index of suspicion is required to prevent a delay in surgery.

Looking at the cancellation rate among renal patients and ways to reduce cancellation at the time of admission and improve utilisation of the theatre list: a quality improvement project

Cancellation on the day of surgery is a major challenge faced by the UK NHS and it was estimated that it costs the NHS £400 million per year on lost operating theatre time costs.1 It was reported that renal patients have a higher than average cancellation rate on the day of surgery (eg elective renal access procedures) due to illness. The standard should be that no patients cancel on day of surgery and all …

The 'Surgical Time': a myth or reality? Surgeons' prediction of operating time and its effect on theatre scheduling.

Objective In Australia, 2.7 million surgical procedures were performed in the year 2016-17. This number is ever increasing and requires effective management of operating theatre (OT) time. Preoperative prediction of theatre time is one of the main constituents of OT scheduling, and anecdotal evidence suggests that surgeons grossly underestimate predicted surgical time. The aim of this study is to assess surgeons' accuracy at predicting OT times across different specialties and effective theatre scheduling. Methods A database was created with de-identified patient information from a 3-month period (late 2016). The collected data included variables such as the predicted time, actual surgery time, and type of procedure (i.e. Emergency or Elective). These data were used to make quantifiable comparisons. Results Data were categorised into a 'Theatre list' and 'Scopes list'. This was further compared as 'Actual-Predicted' time, which ranged from an average underestimation of each procedure by 19min (Ear Nose and Throat surgeons) to an average overprediction of 13.5min (Plastic Surgery). Urgency of procedures (i.e. Emergency and Elective procedures) did not influence prediction time for the 'Theatre list', but did so for the 'Scopes list' (P<0.001). Surgeons were poor at predicting OT times for complex operations and patients with high American Society of Anaesthesiologists grades. Overall, surgeons were fairly accurate with their OT prediction times across 1450 procedures, with an average underestimation of only 2.3 min. Conclusions In terms of global performance at The Queen Elizabeth Hospital institution, surgeons are fairly accurate at predicting OT times. Surgeons' estimates should be used in planning theatre lists to avoid unnecessary over or underutilisation of resources. What is known about the topic? It is known that variables such as theatre changeover times and anaesthesia time are some of the factors that delay the scheduled start time of an OT. Furthermore, operating time depends on the personnel within the operating rooms such as the nursing staff, anaesthesiologists, team setup and day of time. Studies outside of Australia have shown that prediction models for OT times using individual characteristics and the surgeon's estimate are effective. What does this paper add? This paper advocates for surgeons' predicted OT time to be included in the process of theatre scheduling, which currently does not take place. It also provides analysis of a wide range of surgical specialties and assesses each professions' ability to accurately predict the surgical time. This study encompasses a substantial number of procedures. Moreover, it compares endoscopic procedures separately to laparoscopic/open procedures. It contributes how different variables such as the urgency of procedure (Emergency/Elective), estimated length of procedure and patient comorbidities affect the prediction of OT time. What are the implications for practitioners? This will encourage hospital administrators to use surgeons' predicted OT time in calculations for scheduling theatre lists. This will facilitate more accurate predictions of OT time and ensure that theatre lists are not over or underutilised. Moreover, surgeons will be encouraged to make OT time predictions with serious consideration, after understanding its effect on theatre scheduling and associated costs. Hence, the aim is to try to make an estimation of OT time, which is closer to the actual time required.

Setting up preanesthesia evaluation clinic – An experience of planning and establishment at a private medical college and hospital

BACKGROUND: Preanesthesia evaluation (PAE) (also called preanesthetic assessment or preanesthesia checkup) is a detailed medical checkup and laboratory investigations performed by the anesthesiologist before a surgical procedure, to assess the patient's physical condition and any other medical illnesses or diseases the patient might be suffering from. Dedicated outpatient PAE clinics are fairly latest phenomenon, and information is thin from developing world. The role of PAE clinic is to evaluate all patients for surgical procedures requiring general or regional anesthesia before hospital admission, whether for day-care surgical procedures or for inpatient surgical procedures. Optimal use of PAE clinic avoids unnecessary postponements, suboptimal utilization of operation theater, and personnel and parental time. AIMS: The aim of this study was to describe the methods, challenges, and opportunities that we came across in setting up a PAE clinic in a university-based tertiary care teaching hospital attached to a medical college at Mysuru in South India. MATERIALS AND METHODS: The PAE clinic was planned to set up in the outpatient department area of this medical college cum tertiary care hospital, manned by a multimodal team. RESULTS: With the utilization of available resources, the establishment of daily PAE clinic was possible in this university-based tertiary care teaching hospital. CONCLUSION: PAE is a clinical base and framework for perioperative patient management. This article describes a scalable model that can be replicated in similar resource-constrained hospitals/health-care organizations.