Scheduled Surgery Research Articles

Will videoteleconsultation have been just a stopgap in French orthopedics–traumatology? A national survey of 280 surgeons

IntroductionThere have been no studies assessing French orthopedic surgeons’ satisfaction with video and telephone consultations. These were encouraged during the coronavirus pandemic. We therefore performed a prospective study to assess (1) the profile of physicians using videoteleconsultation (VTC) during the pandemic and factors influencing use, (2) satisfaction with VTC, and (3) the pros, cons and prospects of VTC. HypothesisThe study hypothesis was that VTC in orthopedics–traumatology is sufficiently satisfying to be used in everyday practice outside of pandemic contexts. Material and methodA French nationwide survey was conducted in the form of an assessment of professional practices. Orthopedic and traumatology surgeons were sent a digital questionnaire, using the mailing lists of some of the French professional and scientific societies, with an estimate of 2000 practitioners who could be reached. The survey concerned use of VTC, modalities and satisfaction and the practitioner's profile. On the basis of the questionnaire responses, a Net Promoter Score (NPS) was calculated, evaluating the number (from −100 to +100) of respondents likely to recommend VTC. ResultsIn total 280 of the estimated 2000 practitioners who were contacted (14.0%) responded. Their mean age was 47.7±10.0years (range: 30–84years). The rate of use of VTC rose from 8.9% (n=25/280) before the pandemic to 55.3% (n=155/280) during it. In the 155 practitioners who had used VTC, NPS was −46.4. Only 51% (n=79/155) were in favor of continuing VTCs outside of pandemic settings. Likewise, 50.3% (n=78/155) reported that clinical examination was more time-consuming via VTC than in face-to-face consultation, and 57.4% (n=89/155) said the same about visualizing complementary examinations. Finally, 98.1% (n=152/155) found VTC less satisfying than face-to-face consultation for clinical examination, and only 18.1% (n=28/155) scheduled surgery after VTC alone. ConclusionTo date in French orthopedics–traumatology, VTC does not satisfy surgeons, with its virtual rather than physical clinical examination; even so, it offers a solution in pandemic settings. Level of evidenceIV; prospective study without control group.

Living with brain cancer: From researcher to patient

As an academic researcher, my work-life revolves around testing the efficaciousness of pharmaceutical drugs on the prevention of cardiac dysfunction, arrhythmias, and sudden cardiac death in animal models of heart disease. I never thought I would go from someone studying a life-threatening disease to a patient living with one in twenty-four hours. Yet, that transformation occurred October 8, 2019. I was just appointed to Assistant Professor at Johns Hopkins University School of Medicine (JHUSOM), yet after sitting for my professional headshot I had a grand mal seizure. I cannot recall this event, but I bit the tip of my tongue off, dislocated my right shoulder, and underwent violent contractions. I was rushed to the Emergency Department, thankfully within the same building (JHUSOM). A few scans later, I was told I had ‘a mass’ in my brain that needed to be removed immediately. Fearing the worst, I followed the advice of my newly appointed neurosurgeon and scheduled surgery for October 19, 2019. I had no time to process what had and what was about to happen. What followed was two years of post-surgical recovery during a global pandemic, my own personal awe in the power of medicine, resurgence of my seizures and tumors, and now – my road to recovery through chemotherapy and radiation. These two years have taught me so much about the day-to-day difficulties patients with chronic diseases live with, strategies I use to cope with my new normal, and most importantly, the necessity of caregivers.

Incidence and Risk Factors of Postoperative Complications in General Surgery Patients.

Background Postoperative complications, which are undesirable consequences of surgery, need to be minimized to ensure the quality of surgical care. In this study, we aimed to estimate the incidence and identify the risk factors for postoperative complications which may help in planning appropriate preventive measures. Methodology A prospective observational study was conducted in the general surgery department of a tertiary care hospital in a metropolitan city in India. Patients undergoing elective or emergency surgery were included. Patients transferred postoperatively from other hospitals and those undergoing day-care operations or endoscopic procedures were excluded. Age, gender, body mass index (BMI),comorbidities, surgical risk as per American Society of Anesthesiologists(ASA) grading, scheduling of surgery (emergency, semi-emergency, or elective), approach (open or laparoscopic), intraoperative complications, operative blood loss, the extent of surgery (superficial or deep cavity), indication (diagnostic, therapeutic, or palliative), duration of surgery, wound class (clean, clean-contaminated, contaminated, or dirty), and duration of hospital stay in days were recorded.Patients were followed up for 30 days postoperatively for complications (defined as any undesirable, unintended event as a direct result of an operation). Clavien-Dindo classification was used to grade the severity of complications. The chi-square test was used for categorical data, and the t-test was used for numerical data. P-values <0.05 were considered significant. Results Postoperative complications were observed in 31.50%; minor complications (Grade I and II) in 19.75% and major complications (Grade III and IV) in 8.0% of patients. Postoperative mortality (Grade V) was 3.75%. Significant risk factors were the presence of comorbidities, higher ASA grade, higher BMI, emergency surgery, open surgery, palliative surgery, deeper cavity surgery, higher intraoperative blood loss, prolonged surgical duration, intraoperative complications, and contaminated surgical wounds. Postoperative complications significantly prolonged the hospital stay. Conclusions Understanding risk factors can guide surgeons to adopt appropriate strategic measures to reduce postoperative complications and improve the quality of surgical care. Three key measuresemerging from this study are (1) preoperative patient optimization; (2)diligence during surgery to reduce operative time, blood loss, and intraoperative complications; and (3) implementation of infection control practices.

Surgical Practice Patterns in the Management of Ovarian Torsion

<h3>Study Objective</h3> Ovarian torsion (OT) is a common gynecologic emergency with the potential for significant lifelong health and fertility sequelae. We aimed to evaluate surgical practice patterns in the management of patients with concern for OT, in particular factors associated with oophorectomy versus ovarian preserving surgery (OPS) and rates of minimally invasive surgery (MIS). <h3>Design</h3> Retrospective cohort analysis <h3>Setting</h3> Tertiary medical center <h3>Patients or Participants</h3> All patients presenting acutely with symptoms concerning for OT who underwent surgical management between 2016-2021. Patients with incidental torsion at the time of scheduled surgery were excluded from this analysis. <h3>Interventions</h3> Evaluation of patient demographics, background clinical context, imaging findings, and surgical variables including primary specialty, surgical approach, procedures performed, and perioperative outcomes. <h3>Measurements and Main Results</h3> One hundred twenty-six-patient underwent 129 surgeries for suspected ovarian torsion. Of this, 75 cases (59.52%) were confirmed to be torsed. In total, 73 (57.9%) patients underwent OPS while 52 (41.3%) underwent oophorectomy. Patients who underwent OPS compared to oophorectomy were noted to be significantly younger (mean age 23.3 vs 29.3, p = 0.012) and have a lower BMI (mean 25.0 vs 29.7, p = 0.011). The proportion of OPS cases varied significantly by subspecialty with OPS performed in 56.9% of cases performed by Obstetrics and Gynecology generalists, 67.7% of cases by minimally invasive gynecologic surgeons (MIGS), 6% of cases by gynecologic oncologists (GO), and 79% of cases by pediatric surgeons. This data is confounded by patient age, fertility goals, and concern for malignancy. 90.28% of OPS cases were performed via a MIS approach while 69.2% of oophorectomies were MIS. MIS rates varied significantly by surgical subspecialty: 88% among generalists, 96.7% among MIGS, 60% among gynecologic oncologists, and 60% among pediatric surgeons. <h3>Conclusion</h3> The surgical management of OT varies widely. Our data supports that age, BMI, and surgical subspecialty influence surgical approach and management.

Rheumatic Heart Diseases: Epidemiological, Diagnostic and Therapeutic Aspects at The Cardiology Clinic Fann Hospital in Dakar

Introduction: Rheumatic heart disease are a serious complication of acute articular rheumatism. They remain frequent in our underdeveloped countries and in Senegal in particular. Late diagnosis and lack of early and appropriate management put people at risk of serious and sometimes fatal complications. The purpose of our study was to report the epidemic profile and outcomes of rheumatic valve disease management. Methodology: We conducted a retrospective and descriptive study including patients hospitalized from January 1st, 2017 to June 31th, 2019 for rheumatic valve disease in cardiac surgery or medical cardiology department. The various parameters studied were epidemiological, diagnostic and prognostic data. Data analysis was done by the Statistical package for Social Sciences (SPSS) version18. Results: We collected 102 cases. The average age was 20.57. The Male/Female sex ratio was 1.12. Fifty-six patients were hospitalized for scheduled surgery, 43 for decompensated heart failure and 03 for infectious endocarditis. Mitral valve regurgitation was the most common valve disease (19.61%). Poly-valvular involvement was dominated by mitral disease and aortic valve regurgitation (32.35%). Seventy-five patients, or 73.5%, had received surgical treatment, including valve replacement in 67.15% of cases and valvuloplasties accounted for 37.83%. Percutaneous mitral commissurotomy was performed in 03 patients. The medical treatment was for heart failure and infectious endocarditis. The trend was favourable in 86.2% of cases. Twenty-eight patients were lost sight. Medium-term mortality was 13.7% or 14 patients. Conclusion: Rheumatic heart diseases remain common in our regions, they must be detected early for better management. The treatment is typically surgical but is often lacking hence the importance of the prevention of rheumatic arthritis.

An adaptive-learning-based genetic algorithm for collaborative scheduling of distributed operating rooms

To improve surgical services and hospital performance, collaborative operating room planning and scheduling across a network of hospitals has recently emerged as a new challenge in both healthcare industry and academic community. The paper considers a novel distributed operating room scheduling problem (DORSP), in which elective patients planned on a given day are scheduled for surgeries in the distributed operating rooms of collaborative hospitals. Since hospitals are different in terms of specialization and medical expertise, some complicated surgeries in this problem can only be performed in a subset of collaborative hospitals. Based on the similarities between healthcare delivery systems and production systems, DORSP is modelled as a distributed two-stage no-wait hybrid flow shop scheduling problem with factory eligibility. To deal with the NP-hardness of DORSP, an adaptive-learning-based genetic algorithm (ALBGA) is proposed to generate collaborative surgery schedules. In addition to traditional genetic operators, ALBGA also applies an adaptive learning operator to enhance the search ability by mimicking human learning behaviours. Computational results on both small-sized and large-sized test problems show that ALBGA is competitive among the compared algorithms.

Predicting Hospital Admissions to Reduce Crowding in the Emergency Departments

Having an increasing number of patients in the emergency department constitutes an obstacle to the admissions process and hinders the emergency department (ED)’s ability to deal with the continuously arriving demand for new admissions. In addition, forecasting is an important aid in many areas of hospital management, including elective surgery scheduling, bed management, and staff resourcing. Therefore, this paper aims to develop a precise prediction model for admissions in the Integral Healthcare System for Public Use in Catalonia. These models assist in reducing overcrowding in emergency rooms and improve the quality of care offered to patients. Data from 60 EDs were analyzed to determine the likelihood of hospital admission based on information readily available at the time of arrival in the ED. The first part of the study targeted the obtention of models with high accuracy and area under the curve (AUC), while the second part targeted the obtention of models with a sensitivity higher than 0.975 and analyzed the possible benefits that could come from the application of such models. From the 3,189,204 ED visits included in the study, 11.02% ended in admission to the hospital. The gradient boosting machine method was used to predict a binary outcome of either admission or discharge.

Preoperative Fibrinogen-to-Albumin Ratio as Potential Predictor of Bladder Cancer: A Monocentric Retrospective Study.

Background and objective: Fibrinogen and albumin are two proteins widely used, singularly and in combination, in cancer patients as biomarkers of nutritional status, inflammation and disease prognosis. The aim of our study was to investigate the preoperative fibrinogen-to-albumin ratio (FAR) as a preoperative predictor of malignancy as well as advanced grade in patients with bladder cancer. Materials and Methods: A retrospective analysis of patients who underwent TURBT at our institution between 2017 and 2021 was conducted. FAR was obtained from preoperative venous blood samples performed within 30 days from scheduled surgery and was analyzed in relation to histopathological reports, as was the presence of malignancy. Statistical analysis was performed using a Kruskal–Wallis Test, and univariate and multivariate logistic regression analysis, assuming p < 0.05 to be statistically significant. Results: A total of 510 patients were included in the study (81% male, 19% female), with a mean age of 71.66 ± 11.64 years. The mean FAR was significantly higher in patients with low-grade and high-grade bladder cancer, with values of 80.71 ± 23.15 and 84.93 ± 29.96, respectively, compared to patients without cancer (75.50 ± 24.81) (p = 0.006). Univariate regression analysis reported FAR to be irrelevant when considered as a continuous variable (OR = 1.013, 95% CI = 1.004–1.022; p = 0.004), while when considered as a categorical variable, utilizing a cut-off set at 76, OR was 2.062 (95% CI = 1.378–3.084; p < 0.0001). Nevertheless, the data were not confirmed in the multivariate analysis. Conclusions: Elevated preoperative FAR is a potential predictor of malignancy as well as advanced grade in patients with bladder cancer. Further data are required to suggest a promising role of the fibrinogen-to-albumin ratio as a diagnostic biomarker for bladder tumors.

X-ray Microtomography to Assess Determinants of In Vivo N-Butyl Cyanoacrylate Glubran®2 Polymerization: A Rabbit-Model Study.

Although introduced decades ago, few cyanoacrylate glues have been approved for endovascular use, despite evidence of their usefulness, notably for complex procedures suchas hemostatic embolization. Indications include massive bleeding requiring emergent hemostasis and prevention of severe bleeding during scheduled surgery to remove a hypervascular tumor. Adding radiopaque Lipiodol Ultra Fluid® (LUF) modulates glue polymerization and allows fluoroscopic guidance, but few comparative in vivo studies have assessed the impact of the resulting change in glue concentration or of other factors such as target-vessel blood flow. In a rabbit model, we used ex vivo X-ray microtomography to assess the results of in vivo renal-artery embolization by various mixtures of N-butyl cyanoacrylate (NBCA), metacryloxysulfolane, and LUF. Overall, penetration to the superficial interlobular arteries was achieved in about two-thirds of cases and into the capillaries in nearly half the cases, while cast fragmentation was seen in slightly more than half the cases. Greater NBCA dilution and the blocked-blood-flow technique were independently associated with greater distality of penetration. Blocked-blood-flow injection was independently associated with absence of fragmentation, capillary penetration, a shorter cast-to-capsule distance, and higher cast attenuation. A larger mixture volume was independently associated with higher indexed cast ratio and deeper penetration. Finally, microtomography is an adapted tool to assess ex vivo distribution of glue cast.

COVID-19 and Eye Banking: Ongoing Impacts of the Pandemic.

The purpose of this study was to assess the impact of ongoing waves of the COVID-19 pandemic and resulting guidelines on the corneal donor pool with resumption of clinical operations. A retrospective analysis of donors deemed eligible for corneal transplantation at an eye bank from July 1, 2020, through December 31, 2021. Donors ineligible due to meeting Eye Bank Association of America (EBAA) COVID-19 guidelines or a positive postmortem COVID-19 testing were examined. The correlation between COVID-19 rule outs and state COVID positivity was calculated. The number of scheduled surgeries, suitable corneas, imports, and international exports was compared with a pre-COVID period. Postmortem testing was reduced for the final 5 months of the study, and numbers were compared before and after the policy change. 2.85% of referrals to the eye bank were ruled out because of EBAA guidelines. 3.2% of postmortem tests were positive or indeterminate resulting in an ineligible tissue donor (0.42% of referrals). Over the 18-month period, there was a 4.30% shortage of suitable corneas compared with transplantation procedures. There was a significant correlation between postmortem testing and state COVID-19 positivity (r = 0.37, P <0.01), but not with EBAA guidelines (r = 0.19, P = 0.07). When postmortem testing was reduced, significantly more corneas were exported internationally. Although corneal transplant procedures were back to normal levels, there was a shortage of suitable corneal tissue. The discontinuation of postmortem testing was associated with a significant increase in international exports of corneal donor tissue.

P-150 TRANSVERSUS ABDOMINIS RELEASE BY MINIMAL INVASIVE SURGERY. OUR EXPERIENCE IN A TERCIARY HOSPITAL

Abstract Aim We present the experience in the transversus abdominis release (TAR) technique using a minimally invasive approach in our center. Methods We expose those W3 defects intervened by laparoscopic TAR(n=6). Step 1: Releasing adhesions from previous surgeries. Step 2: Bilateral Rives space dissection, as well as the Rossen's space, this one using “down to up” technique. Step 3: Closure of the gap with barbed suture. In all cases, a PVDF mesh has been associated with atraumatic fixation, and 2 drains were placed. Results The mean age was 62, 100% men, and their BMI was greater than 25Kg/m2. All underwent scheduled surgery, using a minimally invasive approach, placing the mesh at the retromuscular level. Postoperative stay was 7.6 days. We did not obtain major complications (perforation, bleeding), but a drainage hole wound infection was registered. We had no readmissions or any medical complications. Follow-up of 12 months, without signs of recurrence or chronic pain. Conclusions Although Robotic surgery and Botulinum toxin in surgery seems to be the future, in our experience TAR technique performed by laparoscopy is useful for large midline incisional hernias treatment as well as those associated with a lateral component in a terciary Hospital. We obtain good results in terms of recurrence and restoration of the abdominal wall dynamics. However, further studies are necessary to be carried out by experienced teams to reach conclusions.

Self-withdrawal from scheduled bariatric surgery: Qualitative study exploring patient and healthcare provider perspectives.

The objective of the study was to explore the experience of patients who self-withdrew from their scheduled bariatric surgery (BS) after completing the lengthy multidisciplinary assessment and optimization process, and to examine how these withdrawals affect healthcare providers (HCPs) in a Bariatric Centre of Excellence (BCoE). Interviews were conducted with patients who self-withdrew, within 1 month, from scheduled BS. Additionally, a focus group with HCPs from the same BCoE was completed. The data were analysed using an inductive, emergent thematic approach with open coding in NVivo 12, with comparative analysis to identify common themes between groups. Eleven patients and 14 HCPs participated. HCPs identified several behavioural and logistical red flags among patients who self-withdrew from scheduled BS. Patients and HCPs felt the decision was appropriate, owing to a patient's lack of mental preparedness for change, social supports, or fears of postoperative complications. HCPs reported frustration and described negative impacts on clinic efficiency. Additional mental health resources for patients contemplating self-withdrawal, such as peer support, were suggested. In conclusion, a patient's decision to self-withdraw from a scheduled BS is often sudden, definite, and associated with anxiety, fear of surgical risks and post-operative complications. Additional mental health resources at a BCoE may be beneficial to support patients at risk of self-withdrawal from scheduled BS.

Implications for limiting visits to patients residing in hospital wards during the COVID-19 pandemic

The impact of COVID-19 on the healthcare system has been devastating, as the system has had to undergo major changes, including the postponement of scheduled surgeries, the admission of patients in a state of emergency, and the use of teleportation. At the same time, the COVID-19 pandemic caused restrictions on visits to hospitalized patients by relatives, despite recommendations for family visits to patients in hospitals, as an important component of quality care provided. Material and methods: The study included 198 relatives of hospitalized patients in the period from March 2020 to March 2022 in the Silesian province. To achieve the research objective, a questionnaire developed entirely by the Authors, consisting of 9 questions, was used. The questionnaire concerned the assessment of restrictions on visits to hospitalized patients by relatives during the pandemic. The survey was conducted between November 2021 and March 2022. Results: The majority of relatives (91%) indicated that they were able to contact (including by phone) the patient every day during their hospital stay. At the same time, the largest number of respondents marked the answer that visiting patients during their stay in the hospital ward was prohibited (97%). In addition, 39% of respondents answered that it was "rather bad" to restrict visits to a loved one staying in the hospital during the pandemic. Conclusions: Undoubtedly, when considering the implementation of rules restricting patient visitation during the COVID-19 pandemic, relevant authorities should carefully look at and compare the potential harm of the issued decision to restrict visitation by relatives along with the risk of virus transmission. Currently, there are insufficient studies formally assessing the effects of restrictions on patient visits by relatives. However, it is clear from the authors' survey that the majority of relatives are rather negative about the implemented restrictions on patient visits.

Prediction of depression among patients with cardiovascular disease scheduled cardiac surgery using an AI-empowered pipeline

Abstract Introduction Several studies have demonstrated, that one in three patients with cardiovascular disease (CVD) suffers from depression, and depression increases the likelihood for cardiac morbidity and mortality in the CVD population by 2–3-fold, independently of traditional risk factors or gender. Purpose The aim of this work is to predict depression in patients with CVD. Methods The clinical study was conducted in the cardiac surgical intensive care unit of The Central Clinical Hospital, the Medical University of Lodz in Poland, among patients scheduled for elective coronary artery bypass graft surgery (CABG). 224 patients signed an informed consent form, met the inclusion criteria and were enrolled in the study. All the patients had chronic coronary syndromes. The inclusion criteria were: consecutive adult patients scheduled for CABG surgery or CABG surgery with cardiac valve repair or replacement (CVR). The study population was examined by a psychiatrist the day prior to the scheduled operation, a diagnosis of major depressive disorder (MDD) was established on the basis of DSM-5 criteria. A data curation pipeline was applied to automatically remove outliers and duplicated fields in the input dataset. An AI-empowered pipeline was developed to classify patients at higher risk for depression. Random downsampling with replacement was applied to deal with the increased class imbalance by taking into consideration two confound factors, namely the Mini Mental State Examination and Hemoglobin concentration &amp;lt;10mg/dl. The downsampling process was repeated K times. In each iteration, three bagging and boosting ML schemas were utilized for the classification task including the AdaBoost (adaptive boosting), Random Forests and Extreme Gradient boosting trees (XGBoost). To this end, a nested cross-validation process was applied for hyperparameter optimization and model validation, where: (i) a 3-fold cross-validation process was first applied to seek for the optimal set of hyperparameters based on the grid search approach by tuning core parameters, including the learning rate, number of estimators, and max depth, among others, and (ii) a stratified 5-fold cross-validation process was subsequently used to evaluate the performance of the best model from the previous stage by computing the classification accuracy, sensitivity, specificity, and area under the ROC curve (AUC). The performance evaluation results were averaged across the 5 folds and across the downsampling iterations. Shappley additive explanation analysis was finally applied to provide explainable risk factors for depression. Results sRAGE was significantly correlated with depression (r=0.32, p=0.038). The Random forests classifier presented the highest performance to predict depression (Accuracy: 0.71, Sensitivity: 0.71, Specificity: 0.75 and AUC: 0.74). Conclusions Depression can be predicted with 71% accuracy at patients with CVD and elevated sRAGE values. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): HORIZON2020

Prehabilitation in Patients before Major Surgery: A Review Article

length of stay; mental health; nutrients; preoperative exercise; smoking cessation.

Predictors of home discharge after scheduled surgery for degenerative cervical myelopathy.

Degenerative cervical myelopathy (DCM) is an important public health issue. Surgery is the mainstay of treatment for moderate and severe DCM. Delayed discharge of patients after DCM surgery is associated with increased healthcare costs. There is a paucity of data regarding predictive factors for discharge destination after scheduled surgery for patients with DCM. The purpose of this study was to identify factors predictive of home versus nonhome discharge after DCM surgery. Patients undergoing scheduled DCM surgery who had been enrolled in a prospective DCM substudy of the Canadian Spine Outcomes and Research Network registry between January 2015 and October 2020 were included in this retrospective analysis. Patient data were evaluated to identify potential factors predictive of home discharge after surgery. Logistic regression was used to identify independent factors predictive of home discharge. A multivariable model was then used as a final model. Overall, 639 patients were included in the initial analysis, 543 (85%) of whom were discharged home. The mean age of the entire cohort was 60 years (SD 11.8 years), with a BMI of 28.9 (SD 5.7). Overall, 61.7% of the patients were female. The mean length of stay was 2.72 days (SD 1.7 days). The final internally validated bootstrapped multivariable model revealed that younger age, higher 9-Item Patient Health Questionnaire score, lower Neck Disability Index scores, fewer operated levels, mJOA scores indicating mild disease, anterior cervical discectomy and fusion procedure, and no perioperative adverse effects were predictive of home discharge. Younger age, less neck-related disability, fewer operated levels, more significant depression, less severe myelopathy, anterior cervical discectomy and fusion procedure, and no perioperative adverse effects are predictive of home discharge after surgery for DCM. These factors can help to guide clinical decision-making and optimize postoperative care pathways.

Programmatic Surgical Care in Cured Covid-19 Patients: Prospective Study with Review of the Literature

Objective: Given a possible persistent multi-systemic symptomatology during coronavirus disease 2019. It is important to consider the impact of a previous SARS-CoV-2 infection on the increase in postoperative morbidity and mortality, to that a postponement of the surgery proves to be necessary but this must always be counterbalanced by a potential deleterious effect of the delay of the intervention. The objective of our study is to assess the impact of a SARS-CoV-2 infection on the postoperative evolution in a patient cured of COVID-19 and to discuss the modalities and optimal delays of a planned surgery based on a review of the international literature. Material and Methods: This is a descriptive prospective study of a series of 66 patients with a history of recent confirmed SARS-CoV-2 infection and having had a scheduled surgery within 4 to 8 weeks. after the acute phase, in the operating theater of the Mohamed V military training hospital in Rabat, over a period of 9 months between September 2020 and May 2021. Results: We noted that only 6.06% of patients had a postoperative complication including: 3.03% infection of the surgical site, 1.51% sepsis on a urinary tract infection and 1.51% postoperative bleeding and no death has not been recorded. While in the literature a postponement of scheduled surgery for 7 weeks after SARS-CoV-2 infection is the delay associated with a lower risk of postoperative morbidity and mortality, these delays are really of little contribution in our study.

Assessment of Preoperative Anxiety Among Patients of Open-Heart Surgery at Cardiac Centres of Rawalpindi and Islamabad

Anxiety is a complex emotional condition that is often described as a noxious internal disturbance that is accompanied by restlessness. Objectives: To determine the prevalence of preoperative anxiety and to find out main risk factors among patients waiting for open heart surgery. Methods: A cross-sectional study was carried out at cardiac centers of Rawalpindi. A total of 180 respondents who were admitted in hospital for open heart surgery were consecutively selected for the purpose of the study. APAIS and STAI were used to collect data regarding preoperative anxiety. Adjusted odd ratios were determined for the major risk factors. Results: Majority were males (64.4%) and were 20-46 years of age (48.3%). It can be seen that patients who presented low levels of preoperative anxiety were slightly higher in number as compared to those who presented high levels of anxiety. Females, patients of younger age group (20-46 years) and those undergoing valvular surgeries were more prone to develop all subtypes of preoperative anxiety (p value&lt;0.05). While surgery schedule is also a main predictor of anxiety due to anaesthesia and procedure (p value&lt;0.05). Conclusions: Majority of the patients undergoing open heart surgery presented low levels of preoperative anxiety while females, younger patients and those undergoing valvular surgeries were considered more susceptible of developing preoperative anxiety.

A simulation optimization approach for planning and scheduling in operating rooms for elective and urgent surgeries

Improving operating room efficiency has become one of the most important goals for health care providers given growing expenditures in managing hospital operations. Effective appointment schedules, which minimize the cost of patient waiting time and operating room idle time and overtime, play an important role in terms of improving efficiency. The variability inherent in surgical procedure times and random arrival of urgent cases significantly complicates the scheduling process. In this study, we compare several strategies for scheduling outpatient surgical procedures in the presence of urgent arrivals. First, a simulation optimization approach is used to find heuristic solutions for a surgery scheduling problem with a heterogeneous set of elective and urgent procedures in a multiple operating room setting. Second, a discrete-event simulation model is used to numerically evaluate how different sequencing and allocation policies perform for multiple surgery procedure types. Historical surgery procedure data for a hospital providing day surgeries over a two-year period from the Canadian Institute for Health Information (CIHI) database will be used to provide empirical support for the input parameters of the model.

Clinical Rotation Handbook Promotes Orthopaedic Resident Wellness: A Quality Improvement Study.

IntroductionTransitioning from one clinical rotation to the next may be particularly stressful for orthopaedic residents attempting to navigate new work environments with new faculty mentors and new patients. The purpose of this quality improvement (QI) project was to determine if resident stress could be improved by using a handbook to disseminate key rotation-specific data during quarterly rotation transition periods.MethodsA comprehensive electronic handbook was created by residents to describe each rotation in our orthopaedic training program in terms of: (1) faculty and staff contact data, (2) daily clinic and surgery schedules, (3) resident responsibilities and faculty expectations, and (4) key resources and documents. At rotation transition, a session in the academic schedule was dedicated for outgoing residents to update the handbook and to sign-out to incoming residents. Pre- and post-handbook questionnaires were administered to assess resident perceptions of stress or anxiety, preparedness, and confidence before commencing the new rotation. Nonparametric data derived from the surveys were analyzed using the sign test choosing p < 0.05 for a two-tailed test as the level of statistical significance.ResultsMost residents perceived improvements in stress/anxiety, preparedness, and confidence understanding rotation expectations after the handbook was implemented. Changes in these three outcome parameters were statistically significant.ConclusionsThis rotation transition QI initiative consisting of a resident-authored, rotation-specific electronic handbook and dedicated verbal sign-out session enhanced resident wellness by decreasing stress, increasing preparedness, and improving confidence among residents starting a new rotation. Similar online resources may be useful for trainees in other specialties.