Cancellation Of Surgery Research Articles

Abstract PO1-17-10: Impact of COVID19 on neoadjuvant endocrine therapy use in breast cancer: A National Cancer Database analysis

Abstract Background: Neoadjuvant endocrine therapy (NET) is associated with similar response rates as neoadjuvant chemotherapy in hormone receptor positive (HR+) breast cancer (BC), with less toxicity. While gene expression assays such as the 21-gene recurrence score (RS) have led to decreased chemotherapy use in early HR+/HER2- BC, NET is often underutilized. In 2020, the COVID19 pandemic led to disruption in oncologic care, including cancellation of surgeries. Guidelines for BC management during the pandemic recommended NET for HR+/HER2- BC patients unable to obtain surgery due to pandemic restrictions. We evaluated NET use in 2020, compared to NET use in prior years. Methods: Female pts with nonmetastatic HR+/HER2- BC diagnosed between 2016 and 2020 were identified from the 2004-2020 National Cancer Database (NCDB). Annual number of pts receiving NET, and duration of use, were compared between years, and characteristics of pts treated with and without NET were evaluated within and across years, using Chi-squared test for categorical variables and Wilcoxon rank-sum test or Kruskal-Wallis test for continuous variables. Results: 554,733 pts met inclusion criteria; 84.50% white, 9.19% Black, 4.06% Asian; 5.88% Hispanic. 25,553 (4.61%) pts received NET. Annual NET use increased slightly between 2016 and 2018 [3.25% vs 3.49% (p=0.021) vs 3.89% (p < 0.0001)], remained stable in 2019 (3.98%), and then increased to 8.67% in 2020 (p < 0.0001). Median duration of NET remained relatively stable between 2016 and 2019 [74 days (d), 68d, 73d and 61d, 2016-2019] but declined in 2020 (56d, p< 0.0001 for 2020 vs 2016, 2017, 2018, and 2019). Older age and greater comorbidities were associated with NET use in all years (p < 0.0001). No racial association with NET use was seen in 2016-2018, but Black race was associated with greater NET use in 2019 (p=0.0122) and 2020 (p < 0.0001). Lobular histology, moderate grade, larger tumor size, and node involvement were associated with increased NET use in all years (p < 0.0001). Progesterone receptor positivity (PR+) and lower Ki67 were associated with NET use in 2020 (p=0.0007 and p< 0.0001), but not prior. Median tumor size for pts receiving NET was smaller in 2020 (16mm) compared with prior years (22, 23, 22, and 21mm for 2016-2019, p< 0.0001). Annual RS use increased for all pts between 2016 (34.59%) and 2020 (43.47%). RS use in NET pts was stable in 2016 (27.79%) and 2017 (27.54%), with modest increase in 2018 (29.56%; p 0.094, 2016 vs 2018, p=0.045, 2017 vs 2018), and then increased annually in 2019 (33.28%, p=0.0001) and 2020 (40.64%, p< 0.0001). Median RS was higher in pts receiving NET than in pts who did not in 2016-2019 (p=0.0078, 0.0003, 0.0271, and < 0.0001), but was similar in 2020 (RS=16; IQR 11, 22). Conclusions: Frequency of NET administration more than doubled in 2020, but duration was shorter than in prior years, possibly due to use of NET as “bridging therapy” due to COVID19 restrictions. Black race was associated with receipt of NET in 2020, possibly reflecting disparate impact of COVID19 on Black communities. NET use in 2020 was also associated with smaller tumor size, lower Ki67, and greater likelihood of PR+ disease than in prior years. Use of RS to guide NET increased annually, beginning in 2018. Association of NET with older age, greater comorbidities, higher stage, moderate grade, and lobular histology were seen in all years. Citation Format: Della Makower, Jaeun Choi, Susan Fineberg. Impact of COVID19 on neoadjuvant endocrine therapy use in breast cancer: A National Cancer Database analysis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-17-10.

ENHANCING ELECTIVE SURGERY MANAGEMENT WITH OPENPREDICTOR: VALIDATION OF A CLINICAL DECISION AID FOR OPTIMIZING ELECTIVE PATHWAYS

OpenPredictor, a machine learning-enabled clinical decision aid, has been developed to manage backlogs in elective surgeries. It aims to optimise the use of high volume, low complexity surgical pathways by accurately stratifying patient risk, thereby facilitating the allocation of patients to the most suitable surgical sites. The tool augments elective surgical pathways by providing automated secondary opinions for perioperative risk assessments, enhancing decision-making. Its primary application is in elective sites utilising lighter pre-assessment methods, identifying patients with minimal complication risks and those high-risk individuals who may benefit from early pre-assessment.The Phase 1 clinical evaluation of OpenPredictor entailed a prospective analysis of 156 patient records from elective hip and knee joint replacement surgeries. Using a polynomial logistic regression model, patients were categorised into high, moderate, and low-risk groups. This categorisation incorporated data from various sources, including patient demographics, co-morbidities, blood tests, and overall health status.In identifying patients at risk of postoperative complications, OpenPredictor demonstrated parity with consultant-led preoperative assessments. It accurately flagged 70% of patients who later experienced complications as moderate or high risk. The tool's efficiency in risk prediction was evidenced by its balanced accuracy (75.6%), sensitivity (70% with a 95% confidence interval of 62.05% to 76.91%), and a high negative predictive value (96.7%).OpenPredictor presents a scalable and consistent solution for managing elective surgery pathways, comparable in performance to secondary consultant opinions. Its integration into pre-assessment workflows assists in efficient patient categorisation, reduces late surgery cancellations, and optimises resource allocation. The Phase 1 evaluation of OpenPredictor underscores its potential for broader clinical application and highlights the need for ongoing data refinement and system integration to enhance its performance.

Machine Learning-Based Approach to Predict Last-Minute Cancellation of Pediatric Day Surgeries.

The last-minute cancellation of surgeries profoundly affects patients and their families. This research aimed to forecast these cancellations using EMR data and meteorological conditions at the time of the appointment, using a machine learning approach. We retrospectively gathered medical data from 13 440 pediatric patients slated for surgery from 2018 to 2021. Following data preprocessing, we utilized random forests, logistic regression, linear support vector machines, gradient boosting trees, and extreme gradient boosting trees to predict these abrupt cancellations. The efficacy of these models was assessed through performance metrics. The analysis revealed that key factors influencing last-minute cancellations included the impact of the coronavirus disease 2019 pandemic, average wind speed, average rainfall, preanesthetic assessments, and patient age. The extreme gradient boosting algorithm outperformed other models in predicting cancellations, boasting an area under the curve value of 0.923 and an accuracy of 0.841. This algorithm yielded superior sensitivity (0.840), precision (0.837), and F1 score (0.838) relative to the other models. These insights underscore the potential of machine learning, informed by EMRs and meteorological data, in forecasting last-minute surgical cancellations. The extreme gradient boosting algorithm holds promise for clinical deployment to curtail healthcare expenses and avert adverse patient-family experiences.

High Rates of Eye Surgery Cancellation in Veterans Related to Mental Health.

Approximately 9 million veterans receive health care at the Veterans Health Administration, many of whom have psychiatric illnesses. The military continues to have higher rates of psychiatric illness compared to the civilian population. Having a diagnosis such as posttraumatic stress disorder or depression may create challenges in using health care services, such as surgery. The aim of this study was to evaluate eye surgery cancellation, risk factors for cancellation, and areas for intervention within the VA. This was a single-center retrospective cohort study. The Veteran Health Information Systems and Technology Architecture were queried to identify all surgical requests at the West Los Angeles VA in 2019. Data collection included sociodemographic information and comorbid medical conditions, including psychiatric illness. Exploratory analyses using univariate logistic regression were used to evaluate factors associated with surgery cancellation. A total of 1,115 surgical requests were identified with a cancellation rate of 23.7% (n = 270). Sociodemographic factors were similar between those with completed and cancelled surgery. However, having a psychiatric diagnosis correlated with surgery cancellation. For all subspecialties, patients with schizophrenia were more likely to have cancellation (odds ratio [OR], 2.53, P = .04). For retina surgery, patients with posttraumatic stress disorder were more likely to have cancellation (OR, 4.23, P = .01). Glaucoma patients with anxiety (OR, 5.78, P = .05) and depression (OR, 4.05, P = .04) were more likely to have cancellation. There was a significant amount of eye surgery cancellations in veterans with variation by subspecialty and comorbid conditions. Having a psychiatric illness was correlated with increased rates of surgery cancellation amongst veterans. Areas to improve surgical utilization include risk stratification and increased support of vulnerable patients before surgery.

Nicotine Screening and Cessation Education Among Patients Awaiting Total Joint Arthroplasty: A Quality Improvement Project.

Orthopedic surgical patients who use nicotine are at a high risk for postoperative complications including infection, respiratory failure, cardiac arrest, and death. Periprosthetic joint infections may result from nicotine-induced immunosuppression and microvascular changes, increasing perioperative morbidity and mortality. These complications result in higher health care costs, increased length of stay, and loss of reimbursement due to readmissions. Four weeks of nicotine cessation prior to arthroplasty decreases these risks; however, perioperative teams may lack reliable nicotine screening and cessation education methods. This project identified inconsistencies in nicotine screening and cessation counseling in the preoperative setting, which contributed to surgery cancellations among patients who required to demonstrate nicotine cessation preoperatively. Standardization of preoperative nicotine screening and patient cessation education resources can improve the identification of orthopedic patients who use nicotine and provide concrete, proven methods of achieving nicotine cessation prior to elective primary arthroplasty. Investment from perioperative staff is essential to ensure success.

Prevalence and causes of gynecological surgery cancellations at Shariati Bandar Abbas hospital

Prevalence and causes of gynecological surgery cancellations at Shariati Bandar Abbas hospital

A retrospective study about cancellation of elective surgeries in a tertiary care hospital

Abstract Introduction: Operation theaters (OTs) are one among the core functionalities in a health care institution that require a considerable amount of 5 Ms—man, machine, money, material, and management. Any idle time or underutilization in the OT creates a huge loss of these resources and is also inconvenient to patients and those on the waiting list. Thus, a planned and well-conceived operational method has to be followed to reduce the cancelations of scheduled cases and to optimally utilize the OTs so that they become more efficient. This study has been done to understand the basic reasons for the cancelation of elective surgeries at a tertiary care hospital and to effectively tackle them by suggesting suitable solutions to overcome these challenges. Objectives: Primarily, to understand the reasons for the cancelation of surgeries in OTs, and secondarily, to put forward suggestions for optimal usage of OTs. Materials and Methods: This was a retrospective study, with Pareto analysis and root cause analysis (RCA) as the tools. Records were obtained from the Central Scheduling Department of the Hospital between January 2020 and November 2022 (35 months). Results: During the study period, 53,177 surgeries were performed in the main OTs. There were 2289 (4.3%) cancelations. Nearly 84% of canceled surgeries were canceled within 24 h. Cancelations were 63% in males and 37% in females. Seventy-nine percent were of Indian nationality, and the rest were of various nationalities. Conclusion: The reasons for the cancelation of elective surgeries were multifactorial. Controlling these, and thus preventing cancelations, is imperative in the effective functioning of the institution as a whole. We recommend thorough evaluation, early preanesthetic checkup (PAC) and well-planned scheduling without haste as some of the measures to reduce the chances of cancelation.

Factors associated with preoperative delays or cancellations of scheduled non-obstetric surgeries

Factors associated with preoperative delays or cancellations of scheduled non-obstetric surgeries

Enhancing Safety in Tumescent Liposuction: Managing Sedation-Related Respiratory Issues and Serious Complications Under Deep Sedation with the Propofol-Ketamine Protocol.

Over the past 4years, aesthetic surgery, notably liposuction, has substantially increased. Tumescent liposuction, a popular technique, has two variants-true tumescent liposuction (TTL) and semi-tumescent liposuction. While TTL reduces risks, it has limitations. There is no literature reported on semi-tumescent liposuction under deep sedation using the propofol-ketamine protocol, which is proposed as a potentially safe alternative. The retrospective analysis covered 8years and included 3094 patients performed for tumescent liposuction under deep sedation, utilizing the propofol-ketamine protocol. The evaluation of patient safety involved an examination of potential adverse events with a specific focus on respiratory issues related to sedation, including instances of mask ventilation. Among the 3094 cases, no fatalities were recorded. Noteworthy events included 43 mask ventilation instances, primarily occurring in the initial 10 min. Twelve cases experienced surgery cancellation due to various factors, including respiratory issues. Three patients were transferred to upper-level hospitals, while another three required blood transfusions. Vigilant management prevented significant complications, and other adverse events like venous thromboembolism (VTE), fat embolism, severe lidocaine toxicity, and so on were not observed. The analysis of 3094 tumescent liposuction cases highlighted the overall safety profile of the propofol-ketamine protocol under deep sedation. The scarcity of severe complications underscores its viability. The study emphasizes the significance of thorough preoperative assessments, careful patient selection, and awareness of potential complications. Prompt interventions, particularly in addressing sedation-related respiratory issues, further contribute to positive outcomes for patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Equity in the recovery of elective and oncological surgery volumes after the COVID-19 lockdown: a multicentre cohort study in Italy

BackgroundThe COVID-19 pandemic has had, and still has, a profound impact on national health systems, altering trajectories of care and exacerbating existing inequalities in health. Postponement of surgeries and cancellation of elective surgical procedures have been reported worldwide. In Italy, the lock-down measures following the COVID-19 pandemic caused cancellations of surgical procedures and important backlogs; little is known about potential social inequalities in the recovery process that occurred during the post-lockdown period. This study aims at evaluating whether all population social strata benefited equally from the surgical volumes’ recovery in four large Italian regions.MethodsThis multicentre cohort study covers a population of approximately 11 million people. To assess if social inequalities exist in the recovery of eight indicators of elective and oncological surgery, we estimated Risk Ratios (RR) through Poisson models, comparing the incidence proportions of events recorded during COVID-19 (2020-21) with those in pre-pandemic years (2018-19) for each pandemic period and educational level.ResultsCompared to 2018-19, volumes of elective surgery showed a U-shape with the most significant drops during the second wave or the vaccination phase. The recovery was socially unequal. At the end of 2021, incidence proportions among highly educated people generally exceeded the expected ones; RRs were 1.31 (95%CI 1.21–1.42), 1.24 (95%CI 1.17–1.23), 1.17 (95%CI 1.08–1.26) for knee and hip replacement and prostatic surgery, respectively. Among low educated patients, RR remained always < 1. Oncological surgery indicators showed a similar social gradient. Whereas volumes were preserved among the highly educated, the low educated were still lagging behind at the end of 2021.ConclusionsSurgical procedures generally returned to pre-pandemic levels but the low educated experienced the slowest recovery. An equity-oriented appraisal of trends in healthcare provision should be included in pandemic preparedness plans, to ensure that social inequalities are promptly recognised and tackled.

Reaching consensus on factors impacting optimal use of an orthopaedic emergency theatre in a public hospital.

The operating theatre (OT) complex of hospitals represents areas of considerable expenditure with regard to costs and requires maximum use to ensure optimum cost benefit for both patients and the hospital. Inefficient use of an operating theatre room (OTR) may result in hospital wasteful expenditure and frustrations for patients owing to surgery delays, cancellations and prolonged hospitalisation while waiting. The aim of the study was to explore and describe using a consensus method, factors impacting the use of an emergency orthopaedic theatre that can be optimised in a selected public hospital in Gauteng province. The study was conducted by a professional nurse and orthopaedic surgeon working in the theatre of a selected public hospital in Gauteng province. A qualitative, explorative and descriptive design was adopted. Data were collected using a nominal group technique (NGT) among professional nurses and orthopaedic surgeons. Data analysis was done through cross-analysis where participants reached a consensus on the voted ideas from the group. Consensus was reached and three main themes emerged: (1) inadequate resources; (2) poor organisation and (3) communication. The optimal use of an emergency orthopaedic theatre is influenced by the availability of resources being human and material, good organisation and clear communication. The study has demonstrated that a variety of factors needs to be considered to optimise the use of an orthopaedic emergency theatre. The management of an OT requires a concerted effort from the nurses and doctors.

Identifying dynamic factors influencing surgery cancellations.

Identifying dynamic factors influencing surgery cancellations.

Postoperative Outcomes After Delay or Cancellation of Noncardiac Surgery Due to Results of a Preoperative Dobutamine Stress Echocardiogram

Postoperative Outcomes After Delay or Cancellation of Noncardiac Surgery Due to Results of a Preoperative Dobutamine Stress Echocardiogram

Variability of the treated biomedical waste disposal behaviours during the COVID lockdowns.

Literature review suggests that studies on biomedical waste generation and disposal behaviors in North America are limited. Given the infectious nature of the materials, effective biomedical waste management is vital to the public health and safety of the residents. This study explicitly examines seasonal variations of treated biomedical waste (TBMW) disposal rates in the City of Regina, Canada, from 2013 to 2022. Immediately before the onset of COVID-19, the City exhibited a steady pattern of TBMW disposal rate at about 6.6kg∙capita-1∙year-1. However, the COVID-19 pandemic and its associated lockdowns brought about an abrupt and persistent decline in TBMW disposal rates. Inconsistent fluctuations in both magnitude and variability of the monthly TBMW load weights were also observed. The TBMW load weight became particularly variable in 2020, with an interquartile range 4 times higher than 2019. The average TBMW load weight was also the lowest (5.1 tonnes∙month-1∙truckload-1) in 2020, possibly due to an overall decline in non-COVID-19 medical emergencies, cancellation of elective surgeries, and availability of telehealth options to residents. In general, the TBMW disposal rates peaked during the summer and fall seasons. The day-to-day TBMW disposal contribution patterns between the pre-pandemic and post-pandemic are similar, with 97.5% of total TBMW being disposed of on fixed days. Results from this Canadian case study indicate that there were observable temporal changes in TBMW disposal behaviors during and after the COVID-19 lockdowns.

The Role of Mobile Health Technology in Perioperative Spinal Care: A Systematic Scoping Review and Narrative Synthesis.

Smartphone applications play a crucial role in contemporary healthcare by aiming to enhance patient care through technology. Mobile health (mHealth) applications have proven to have transformative potential in enhancing patients' outcomes in candidates undergoing orthopedic and spinal surgery.In the context of the pervasive use of smartphones and the exponential growth of mHealth apps,totaling over 99,000 in 2021, the applications had a significant impact on lifestyle management,supporting initiatives like smoking cessation with motivational reminders and progress tracking. Patientcompliance is significantly enhanced, reducing surgery cancellations and improving outcomes througheffective adherence to pre-operative treatments and instructions. Physiotherapy receives a substantialboost as mHealth facilitates video-guided exercises, potentially improving compliance and treatmentoutcomes. Data collection takes on innovative dimensions, with mHealth apps capturing post-operativemetrics like physical activity, offering valuable insights into patient recovery trends. Remote care isstreamlined through features like photo uploads and direct messaging, proving especially beneficial intimes of crises such as the COVID-19 pandemic. Despite these merits, challenges emerge, includingissues related to technological literacy, potential discrimination due to paywalls, and concerns aboutpatient data confidentiality. Overcoming these challenges requires standardized approaches, legislativemeasures, and ongoing research to refine and optimize mHealth applications for diverse healthcaresettings.

Prevalence and Causes of Elective Surgery Cancellations After Patients are Taken to the Operating Room: A Prospective, Cross-Sectional Study.

This study aimed to investigate the causes and prevalence of elective surgery cancellations in the operating room, and the clinical outcomes of affected patients. This prospective, cross-sectional study assessed the prevalence and causes of elective surgery cancellations once patients are in the operating room. A tertiary academic referral center hosted the study between January 2022 and January 2023. The study sample consisted of 7,482 adult patients scheduled for elective surgeries and taken to the operating room. The 7,415 completed procedures were in Group 2, whereas the 67 cancelled surgeries were in Group 1. Patients were divided into two groups on the basis of whether their surgeries were completed or cancelled. Factors such as age, American Society of Anesthesiologists (ASA) status, and surgical department were analyzed. The two groups were compared on the basis of age, ASA status, surgical department, and surgery time (month and day). Elective surgery cancellations occurred in the operating room at a rate of 0.9%. Group 1 was substantially older than Group 2 (p<0.001). Group 1 had a larger number of ASA III patients (p<0.001). The department with the highest cancellation rate was ophthalmology (2.5%), followed by general surgery (2.1%), urology (1.5%), and ear, nose, and throat (1.4%). It was possible to avoid 59.7% of cancelations. The study revealed a 0.9% prevalence rate of elective surgery cancelations in the operating room. Older age and higher ASA status greatly influenced these cancellations. Optimized surgery scheduling and patient assessment processes may prevent many of these cancellation.

The Incidence and Associated Factors of Patient Cancellation Scheduled for Elective Surgery From February to May at Debremarkos Comprehensive Spetialized Hospital, Debremarkos, Northwest Ethiopia, 2022 Gc. A Cross Sectional Study

Background: High rates of cancellation of surgical procedures are common in hospital settings, which may subsequently lead to economic loss to hospitals besides the burden given to patients, their families, and medical teams. It is well recognized that cancellation of patients from elective theatre operating lists increases cost, decreases efficiency, duplicates workload, and wastes operating room time. Cancellation of elective surgical procedures also causes significant emotional trauma to the patients as well as their families and the community in general, and its impact on hospital resources is great due to prolonged hospitalization and the high cost of health care [1]. This study aimed to assess the incidence and causes of patient cancellation scheduled for elective surgery in Debre Markos Comprehensive Specialized Hospital., Debremarkos, Northwest Ethiopia, 2022 GC. Methods and Materials: A prospective cross-sectional study was conducted on the cancellation of scheduled surgery at Debremarkos Comprehensive Specialized Hospital with a total of 282 sample size from February-01-May-13 consecutive months of 2022 G C. The data was collected from the operating room daily surgical schedule, preoperative anesthesia record sheet, primary physicians, and the anesthetist responsible for the preoperative assessment and conducting the case and by communicating patients if required. Analysis will be done by using SPSS (Version 20). Descriptive as well as analytic statistics are used for variables and data will be presented by tables, graphs, charts, and texts. Result: A total of 1055 patients were scheduled for elective Surgery in Debremarkos Comprehensive Specialized Hospital. During the study period 282(26.7%) of the patients had their surgery cancelled for various reasons in Debremarkos Comprehensive Specialized Hospital. The two most frequent reasons for cancellation were lack of bed (50.0%) and unfit for anesthesia (15.2%) in DMCSH.Conclusion and Recommendation: In conclusion, the cancellation rate of scheduled surgeries is high in general adult surgery at Debremarkos Comprehensive Specialized Hospital. The majority of causes are foreseeable and avoidable, and many are related to the hospital itself. We recommend that a facility for hospital preadmission be created.

The Incidence and Associated Factors of Patient Cancellation Scheduled for Elective Surgery From February to May at Debremarkos Comprehensive Spetialized Hospital, Debremarkos, Northwest Ethiopia, 2022 Gc. A Cross Sectional Study

Background: High rates of cancellation of surgical procedures are common in hospital settings, which may subsequently lead to economic loss to hospitals besides the burden given to patients, their families, and medical teams. It is well recognized that cancellation of patients from elective theatre operating lists increases cost, decreases efficiency, duplicates workload, and wastes operating room time. Cancellation of elective surgical procedures also causes significant emotional trauma to the patients as well as their families and the community in general, and its impact on hospital resources is great due to prolonged hospitalization and the high cost of health care [1]. This study aimed to assess the incidence and causes of patient cancellation scheduled for elective surgery in Debre Markos Comprehensive Specialized Hospital., Debremarkos, Northwest Ethiopia, 2022 GC. Methods and Materials: A prospective cross-sectional study was conducted on the cancellation of scheduled surgery at Debremarkos Comprehensive Specialized Hospital with a total of 282 sample size from February-01-May-13 consecutive months of 2022 G C. The data was collected from the operating room daily surgical schedule, preoperative anesthesia record sheet, primary physicians, and the anesthetist responsible for the preoperative assessment and conducting the case and by communicating patients if required. Analysis will be done by using SPSS (Version 20). Descriptive as well as analytic statistics are used for variables and data will be presented by tables, graphs, charts, and texts. Result: A total of 1055 patients were scheduled for elective Surgery in Debremarkos Comprehensive Specialized Hospital. During the study period 282(26.7%) of the patients had their surgery cancelled for various reasons in Debremarkos Comprehensive Specialized Hospital. The two most frequent reasons for cancellation were lack of bed (50.0%) and unfit for anesthesia (15.2%) in DMCSH. Conclusion and Recommendation: In conclusion, the cancellation rate of scheduled surgeries is high in general adult surgery at Debremarkos Comprehensive Specialized Hospital. The majority of causes are foreseeable and avoidable, and many are related to the hospital itself. We recommend that a facility for hospital preadmission be created.

The Pre-Operative Evaluation Clinic: An Underutilized Service in Optimizing Analgesic Outcomes in Patients on Buprenorphine, Methadone, and Naltrexone for Substance Use Disorder or Chronic Pain.

Patients receiving methadone, buprenorphine, and naltrexone for either chronic pain or substance use disorder (SUD) pose perioperative challenges. Due to their complex pharmacology, perioperative recommendations continue to evolve. Deviations from these recommendations may result in worse perioperative outcomes. A formal preoperative evaluation (POE) and optimization of patients on these medications are recommended to address these concerns. A single-center retrospective electronic health record review was performed with adult patients on methadone, buprenorphine, and naltrexone undergoing elective surgery between January 1, 2010 and December 31, 2020. The primary outcome of interest was the percentage of patients referred to the POE clinic for evaluation prior to the scheduled elective surgery. In addition, we assessed differences in variables (perioperative opioid, hospital length of stay, perioperative multimodal analgesics, perioperative complications, inpatient pain service consult, readmission within 30 days, cancellation of surgery, addiction medicine consult) based on POE clinic evaluation. This analysis was performed separately for patients prescribed these medications for SUD versus chronic pain. Continuous outcomes were analyzed using linear regression with generalized estimating equations (GEE) and robust variance estimates. A total of 714 patients were included in the final analysis, of which 572 (80%) took buprenorphine, methadone, or naltrexone for chronic pain and 142 (20%) took these medications for SUD. Within the chronic pain and SUD subpopulations, 193 (34%) and 35 (25%) patients had formal POE clinic assessments, respectively. Among those taking these medications for chronic pain, POE clinic evaluation was associated with a higher likelihood for receiving non-opioid multimodal analgesics perioperatively (p = 0.016). Formal preoperative evaluations are currently underutilized in patients who take buprenorphine, methadone, or naltrexone for chronic pain or SUD. These patients may benefit from POE clinic assessment to optimize perioperative outcomes.

An audit on surgery cancellation in a teaching hospital.

Operative procedure cancellations are a dilemma for the healthcare system as well as for the patients. It causes increased workload and cost to our system. For patients, it has major financial, psychological as well as medical consequences. We aim to self-identify the causes of cancellations for efficient operation room management. We performed a retrospective chart review in a tertiary academic medical center for the last 66 months of operative records. Subsequently, we performed thematic coding to categorize causes into distinct categories. Our records showed 5153 cancellations which represent (7.3%) of the total booked procedures. Of these cancellations 91% were ordered before the day of surgery, compared to 9% for same-day cancellations. Cancellations were 58% female patients and 40% male patients. The number one reason for cancellations for both same-day and prior cancellations is the unavailability of the surgical consultant. Surgical procedure cancellations profile is unique among our settings and has changed over time. Over the last 5 years, the number one reason is unavailability of the surgical consultant. Efforts should be made to identify and correct the underlying reasons to improve patient outcomes in our evolving healthcare system.