Surgeon Estimates Research Articles

CASEMIX study: Assessment of patient factors influencing the subprocedure duration of trauma/orthopaedic surgeries

IntroductionThe social and financial burdens of the operative environment remains to be a major problem in modern society. We analyse the impact of the introduction and application of a perioperative cloud system that cross-analyzes the pre-/intraoperative risks to minimize surgical time and maximize operation theater efficiency through improved planning. MethodsTCC-CASEMIX© was introduced to our Department of Trauma Surgery of the University of Szeged to objectively measure intraoperative time durations according to each essential subprocedure. The study is largely divided into pre-operative assessments and intraoperative measurements. Patient data (age, sex, and ethnicity etc.) was registered preoperatively, and the expected time per each essential intraoperative step (skin incision, reduction, fixation etc.) was entered. The steps were then timed intraoperatively by surveyors, and postoperative cross analysis was performed. Our study was divided into two phases; phase 1, the surveying of general trauma / orthopedic cases, and phase two; the examination of high volume surgeries. ResultsAcute cases of Open Reductions and Internal Fixation (ORIF) procedures depended heavily on the presentation of the fracture, and no clear correlations in the risk factors were found. Arthroscopies were a short, high-volume procedure, but there was a large difference between the surgeon's estimates and the operation duration. In high volume surgeries, although individual factors only slightly influenced surgical duration, patient cohort stratification led to a better understanding of factors that impact surgeries, namely the combination of BMI and surgeon years of experience. While the average (Intraoperative Duration) seemed to increase with BMI, younger surgeons were more influenced by the patients BMI. ConclusionA data filtering algorithm-assisted cloud system can be a reliable way to facilitate the planning of operating theater schedules. Patient stratification according to BMI and surgeon years of experience seems to affect intraoperative duration significantly, and the understanding of the risks and intraoperative steps has the potential to forecast surgeries with high precision.

Validity of Estimates of Intraoperative Blood Loss in Pediatric Spinal Deformity Surgery

IntroductionIntraoperative blood loss is a significant concern in pediatric spinal deformity surgery, and numerous reports exist in the literature regarding this issue. Multiple interventions are used to minimize intraoperative blood loss and subsequent need for blood product replacement during and after these procedures. However, a basic question remains regarding the overall accuracy of intraoperative blood loss measurements used to generate these studies. Materials and MethodsWe performed an institutional review board–approved study that compared estimated blood loss (EBL) by the anesthesia provider and surgeon after the completion of surgery for pediatric spinal deformity by a single surgeon. We used the estimate by the anesthesia provider that was to be part of the anesthesia record. The surgeon's estimate was generated based on a formula employing the volume of blood products processed by a Cell-Saver device and available for reinfusion. ResultsWe collected data from 51 patients. The mean EBL (surgeon) was 795.84 mL and mean EBL (anesthesia) was 669.30 mL. The mean percent estimated blood volume loss (%EBVL) (surgeon) was 22.9% and mean %EBVL (anesthesia) was 19.8%. Student t-test analysis demonstrated statistical significance between both sets of values (EBL, p = .010; %EBVL, p = .010). ConclusionsThere was a statistically significant difference in EBL values for this patient sample between the anesthesiologist and orthopedic surgeon; the surgeon's estimates were significantly higher. This difference may be important in interpreting existing studies regarding interventions used to minimize surgical blood loss. In addition, this lack of agreement highlights the need for authors to be more accurate and consistent regarding the source of blood loss data in future clinical studies.