Cancellation Of Surgery Research Articles

A discrete event simulation for improving operating theatre efficiency.

Increasing demand in healthcare services has posed excessive burden on healthcare professionals and hospitals with finite capacity. Operating theatres are critical resources within hospitals that can become bottlenecks in patient flow during high demand conditions. There are substantial costs associated with running operating theatres that include keeping professional staff ready, maintaining operating theatres and equipment, environmental services and cleaning of operating theatres and recovery rooms, and these costs can increase if theatres are not used efficiently. In addition to cost, operating theatre inefficiency can result in surgery cancelations and delays, and eventually, poor patient outcomes, which can be exacerbated under the increase in demand. The allocation of surgeries to operating theatres is explored using a simulation model for patients admitted to inpatient beds and sent for surgery. We proposed a discrete event simulation (DES) to model incoming flow to operating theatres of a major metropolitan hospital. We assessed how changing the configuration of surgery at the target hospital affects Key Performance Indicators relating to theatre efficiency. In particular, the model was used to assess impacts of six different scenarios by defining new/hypothetical theatre case-mix, opening and closing times of theatres, turnaround (changeover) time, and repurposing the theatres. Target performance metrics included theatre utilisation, pre-operative length-of-stay, average reclaimable time, the percentage of total theatre time in a year that could be reclaimed, and patient waiting time. A web-based application was developed that allows testing user-defined scenarios and interactive analysis of the results. Extending the opening hours of operating theatres by 1hour almost halved the number of deferred electives as well as over-run cases but at the expense of reduced theatre utilisation. A one-hour reduction in opening hours resulted in 10 times more deferred elective cases and a negligible increase in theatre utilisation. Reducing turnaround time by 50% had positive effects on theatre management: increased utilisation and less deferred and over-run elective cases. Pooling emergency theatres did not affect theatre utilisation but resulted in a considerable reduction in average wait time and the proportion of the delayed emergency cases. The developed DES-based simulation model of operating theatres along with the web-based user interface provided a useful interrogation tool for theatre management and hospital executive teams to assess new operational strategies. The next step is to embed simulation as ongoing practices in theatre planning workflow, allowing operational managers to use the model outputs to increase theatre utilisation, and reduce cancellations and schedule changes. This can support hospitals in providing services as efficiently and effectively as possible.

Implementation of an enhanced recovery after surgery program including a patient school: Impact on quality of life results

IntroductionEnhanced Recovery After Surgery (ERAS) protocols and educational programmes have been shown to accelerate orthopaedic surgery recovery with fewer complications, and improve patient-reported outcomes (PROs) for different types of surgery. The objective was to evaluate the impact of an ERAS programme including a patient school on health outcomes and PROs for Total Knee Replacement (TKR) surgery. Material and methodsA multidisciplinary group created the programme and the patient school (preoperative consultations where the patients’ surgical processes are explained and are also given instructions for an appropriate perioperative care management). An observational, prospective study was conducted on all patients operated for TKR from March 2021 to March 2022. Main health outcomes were: hospital stay length, surgical complications and surgery cancellations due to a wrong preoperative medication management. PROs evaluated were: patient satisfaction with pain management, the school, and quality of life before and after surgery (EQ-5D). ResultsOne hundred thirty-three patients were included. Median hospital stay length was 3 days (IQR 3-5). Rate of surgical complications was 25.6%. No surgery was cancelled. Patient satisfaction rates with pain management and with the school were 8.10/10 and 9.89/10, respectively. Concerning quality of life, mean improvement in mobility and knee pain after the surgery was 0.66 (p < 0.05) and 0.84 (p < 0.05), respectively. ConclusionsThe ERAS programme including a patient school was highly successful with a fast recovery, a short hospital stay length, no surgery cancellations, and improved PROs.

Association between COVID-19 incidence and postponement or cancellation of elective surgeries in Japan until September 2020: a cross-sectional, web-based survey

ObjectivesThis study aimed to examine whether and how the COVID-19 pandemic has affected the postponement or cancellation of elective surgeries in Japan.Design and settingA cross-sectional, web-based, self-administered survey was conducted...

Development, implementation and evaluation of high-quality virtual preoperative anaesthetic assessment during COVID-19 and beyond: a quality improvement report

BackgroundPreoperative risk factor identification and optimisation are widely accepted as the gold standard of care for elective surgery and are essential for reducing morbidity and mortality. COVID-19 public health restrictions...

A community hospital’s approach towards same-day discharge after minimally invasive hysterectomies during the COVID-19 pandemic.

347 Objectives: We performed a quality improvement project to evaluate the trends and safety of same-day discharge after minimally invasive hysterectomies at a community hospital during the COVID-19 pandemic and beyond. Background: The COVID-19 pandemic created an unprecedented demand on hospital resources as patients rapidly filled hospital beds. From March 16 to May 11, 2020, the Illinois Department of Public Health advised the cancellation of elective surgeries to reduce the burden on the health care system. Same-day discharge after hysterectomy has been trending since before the pandemic, but most research touting its safety describes its success among a select group of patients, generally young with few comorbidities, undergoing simple surgeries. We investigate how Carle Foundation Hospital (CFH) employed same-day discharge after hysterectomies during the pandemic. Methods: As a quality improvement project, we performed a retrospective review of patients who underwent hysterectomies at CFH before the start of the pandemic (November 2019 to February 2020) and afterwards (March to November 2020). Minimally invasive hysterectomies performed using either laparoscopic or robotic approaches were considered. Both benign and oncological cases were included. Same-day discharge was defined as no overnight stay after surgery. Patients discharged day of surgery were compared to those with overnight stays. Patient risk factors analyzed included age, race, body mass index (BMI), ASA score, malignancy, length of operation, estimated blood loss, zip code, and post-operative pain scores. Our primary outcomes were complications, ED visits, and readmissions within 30 days of surgery. Multivariate logistic regression was used to identify factors associated with negative outcomes. Results: From November 2019 to November 2020, 353 patients received minimally invasive hysterectomies at CFH. 294 (72.8%) hysterectomies were performed robotically. Rates of same-day discharge remained at 51% before and during the COVID-19 pandemic. Robotic hysterectomies were more likely to be discharged same day than laparoscopic (54% vs. 36%). Longer procedure time and living further from the hospital were significant predictors of overnight admissions, whereas age, BMI, ASA score, and post-operative pain were not. The rates of complications, ED visits, and readmissions did not significantly increase during this timeframe, nor was same-day discharge associated with a greater risk of negative outcomes overall. Conclusions: Our findings suggest that same-day discharge is safe after minimally invasive hysterectomies for patients who are average risk or below. Furthermore, the implementation of a carefully designed intervention at CFH may be able to safely raise rates of same-day discharge and conserve hospital resources.

Same-Day Cancellation is Higher in Outpatient Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy.

PurposeSafety and efficiency of ambulatory pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) patients is worthy of attention, since patients always have severe systemic diseases. The purpose of this study was to compare the incidence of same-day cancellation of PPV for PDR between outpatients and inpatients and to analyze the causes of cancellations.Patients and MethodsThis is a retrospective review of consecutive PPV procedures for PDR from January 2019 to April 2021 at either the ambulatory or the inpatient surgery center in an academic tertiary referral center. Data on patient surgery plan, same-day surgical cancellation and follow-up were recorded. Differences in cancellation rate and reasons for cancellation (e.g. medical factors, patient reasons and administrative problems) between outpatients and inpatients were compared.ResultsIn total, 1810 consecutive PPV procedures of 1367 patients were identified; 1509 (83.4%) were managed as inpatient surgeries and 301 (16.6%) as outpatient surgeries. The total same-day cancellation rate was 5.2% for all patients. Although outpatients were younger (51 years vs 52 years, P < 0.001), had less proportion of hypertension (60.5% vs 74.0%), coronary artery disease (10.0% vs 18.8%), renal insufficiency (9.3% vs 18.0%) and cerebrovascular diseases (1.0% vs 11.4%) (all P < 0.001), had less proportion of patients with ASA III status (14.9% vs 27.4%, P < 0.001), and had higher proportion of regional anesthesia with MAC (19.9% vs 5.0%, P < 0.001), the cancellation proportion was significantly higher for outpatients than inpatients (12.3% vs 3.8%, P < 0.001). Overall, the most common reason for surgical cancellation was medical factors, occurring more frequently in outpatients than inpatients (91.9% vs 68.4%, P = 0.012).ConclusionSame-day cancellation is higher in outpatient pars plana vitrectomy for proliferative diabetic retinopathy. To reduce ambulatory surgery cancellations, it is important to strengthen the monitoring of preoperative systemic comorbidities and adjust medication if necessary.

Postoperative nosocomial COVID-19 infection in surgical patients during pandemic: A prospective observational cohort study.

Background: increased pressure on healthcare systems and possible risk of nosocomial COVID-19 infection during pandemic urged many guidelines to severely restrict the number of operations. The aim of this study was to investigate the risk of COVID-19 infection and its complications in patients undergoing urgent or elective operations.Methods: a prospective observational cohort study was conducted in a tertiary surgical center and all patients with no preoperative history of COVID-19 undergoing elective or emergent surgeries were included in this investigation. chest computed tomography (CT) scan or polymerase chain reaction (PCR) test were performed on patients before and after surgery.Results183 patients who underwent an operation were enrolled in this study. In postoperative follow-up, 12 patients were positive for COVID-19 infection as identified by RT-PCR and non-contrasted chest CT scans. Regrettably, 2 individuals passed with one of these individuals dying as a direct result of COVID-19 infection. All the 12 cases of post-operative COVID-19 patients underwent elective surgeries.Conclusionthe gathered results indicate a need for the re-evaluation of the risks of operation during the COVID-19 pandemic. If operations are performed while observing protective and preventative protocols, the risk of post-operative nosocomial COVID-19 is significantly reduced. Hence, the consequences imposed on patients by the delay or cancellation of operations (most notably in cancer cases) may outweigh the risk of post-operative COVID-19 infections.

A new (q*, S) policy to manage inventory for low shelf life products facing deterioration in quality and age differentiated requirements

Inventory management of products with short shelf life is a critical problem for managers due to its unique characteristics. The efficient and economical planning to manage inventory of such products is important and the complexity multiplies when such products face a deterioration in quality/effectiveness during its shelf life. This paper proposes a new (q*, S) policy with its mathematical model which will help to establish an efficient and economical system which could handle the above situation. The efficiency of this policy is evaluated by considering blood platelets as an example. Platelet transfusions are vital in patients undergoing chemotherapy and those suffering massive bleeding. Shortage of platelets can lead to cancellation or postponement of major operations and excessive storage can lead to wastage due to its low shelf life. For those patients undergoing chemotherapy and bone marrow transplantations (critical illness patients), young platelets (3 to 4 days’ shelf life) are highly preferred, as it can give significant increase in platelet count and increase the interval between transfusions. However, for general surgery and traumatology patients (less critical cases), platelets of any age will serve the purpose as the deficiency is temporary and bone marrow will be able to produce the required quantity. A new (q*, S) policy is proposed through this study to ensure the supply of young platelets for the treatment of critical illness patients and to strike a balance between the shortage in supply of platelets of any age (less critical illness patients) and the expiration of platelets. From the computational studies conducted, this policy is observed to outperform several existing policies discussed in the literature. Other considerations in this paper are fluctuations in demand in certain months and classification of central blood bank on the basis of the type of hospital it caters to. Another major contribution of this paper is the optimization of facility required to store platelets. Optimizing the order-up-to-level without considering the capacity could lead to wastage of resources as there could be lack of space for storing. Instead of predetermining the capacity of the blood bank to store platelets, the number of machines and its type is optimized in this study. So given a demand and cost profile, facility requirements and order-up-to-level to be maintained that could reduce the overall cost to minimum with reduced shortage and expiry can be determined.

Lunar New Year and Eid al Fitr: the circle of COVID-19

The Lunar new year and Ied Fitri is a national holiday where the mass movement of people is seen. The first potentiates the spread of COVID-19, while the latter is a test for federal management of COVID-19 and the success of its vaccination campaign. Analysis of new confirmed cases, hospitalization and number of elective surgery cancelations due to positive PCR screening in the preoperative period provides a snapshot of herd immunity.

Clinical hypnosis associated with local anesthesia for cardiac catheterization in paediatric population

Hypnosis is a promising non-pharmacologic adjunct treatment for improving pain and interventional anxiety management in paediatric interventions. Its efficiency and impacts in paediatric cardiac catheterization (CC) are unknown. In a prospective monocentric study, all patients aged < 18 years who had CC under hypnosis with local anesthesia from January to December 2021 were included. Pain and anxiety were evaluated by the Analgesia Nociception Index (ANI) measured during the intervention, and the Visual Analogue Scale (VAS) assessed by the patients after the intervention. Sixteen patients were included. Median age was 10.5 years old [4–16 years], median weight was 37 kg [15–79 kg]. Catheterizations were interventional in 10 patients (62.5%), for diagnostic purposes in 6 patients (37.5%) ( Table 1 ). Hypnosis indications were general anesthesia (GA) contraindication in 4 patients (25.0%), need of accurate pressures measurements without GA interference in 2 patients (12.5%) and interventionist/patients preferences in 10 patients (62.5%). In one patient of 4 years old, the hypnotic status was not achieved. Procedures were accomplished successfully in 15 patients (93.7%) without any additional sedation even in challenging cases; large atrial septal defect closed with 39 mm Occlutech device in 16 years old patient, and catheterization in 14 years old patient with Fontan failure, elevated pulmonary vascular resistances, cyanosis (Hemodynamic Vulnerability Score = 5) with GA contraindication. In one case, pulmonary artery pressures normalized comparing to previous catheterization under local anesthesia alone leading to the cancellation of cardiac surgery on mitral stenosis. VAS score was under 5/10 in all patients. ANI remained above 50 (non-painful zone) in all but one patient. No significative decrease of the ANI was found during the intervention comparing to baseline ( P = 0.62). No complications were recorded ( Table 1 ). Paediatric CC are feasible under hypnosis even in complicated cases. Hypnosis was efficient to manage pain and stress in all cases, it ensures more reliable pressures measurements.

A Rural Community Hospital’s Perioperative Surgical Home Model Compared to a Traditional Surgical System

Background: The Perioperative Surgical Home (PSH) was designed by the American Society of Anesthesiologists (ASA) to improve perioperative care through more coordinated and communicative decision-making. PSH has proven success in large urban health centers by reducing surgery cancellation, operating room time, length of stay (LOS), and readmission rates. Yet, only limited studies have assessed the impact of PSH on surgical outcomes in rural areas. Thus, this study compared surgical outcomes – LOS, discharge disposition, and 90-day readmission – at a rural hospital from cohorts before and after the implementation of PSH. Method: An initial model of a PSH system was initiated in a local rural hospital. This newly created clinical team and outpatient clinic retrospectively assessed total joint surgeries occurring from November 2017 to April 2018 (before PSH, n = 324) as well as from November 2018 to April 2019 (after PSH, n = 326). General linear models were used to understand the impact of PSH on rural surgical outcomes. Results: Implementing PSH had a positive impact on LOS (P-value &lt; 0.01), discharge disposition (P-value &lt; 0.01), and readmission (P-value = 0.03).Conclusion: Implementation of the PSH system in a rural, community hospital reduced LOS, 90-day readmission, and increased direct to home discharge. Increased clinical management standardization across internal and external stakeholders was achieved because the PSH clinic enabled a centralized navigation point for clinicians, patients, and their families to better communicate and coordinate care.

COVID-19 effects on operating room cancellations at a pediatric tertiary care hospital: A retrospective cohort study

BackgroundSame-day surgery cancellation results in decreased operating room (OR) utilization, reduced productivity, and inconvenience for patients. We aim to assess the cancellation rates of elective surgeries, identify common causes, and evaluate changes due to the COVID pandemic. MethodsA retrospective cohort study was conducted identifying all same-day surgery cancellations at a tertiary pediatric academic hospital from 1/1/2015 to 12/31/2017 (pre-COVID) and from 4/1/2020 to 3/31/2021 (post-COVID). Statistical analysis was performed using generalized regression with cancellation as the dependent variable. Period, age, ethnicity, gender, preferred language, and insurance were independent variables. ResultsThere were 55465 scheduled cases (41670 before and 13795 after COVID), with 1508 cancellations (2.7%). Of those, 1247 (3.0%) were before COVID and 261 (1.9%) after COVID (p < .001). Of all cases, 56.7% (31475) were male, 55.1% (30595) were non-Hispanic/Latinx whites, 82.3% (45638) spoke English, and 45.5% (25237) had public insurance. The mean age was 8.5 years (SD = 6.03).The decrease in the probability of cancellation was most significant in patients with public insurance, < 1 year-of-age, Hispanic/Latinx who spoke Spanish (pre-pandemic = 4.9% [CI = 4.2%–5.8%]; pandemic = 2.8% [95% CI = 1.9%–4.0%]. Regardless of the period, Hispanic/Latinx patients and those with public insurance had higher rates of surgery cancellations (p < .001). ConclusionThere was a significant decrease in same-day cancellations post-pandemic. We hypothesize that the required pre-operative COVID test helped to minimize same-day cancellations. Increased communication and education enhanced family engagement and was critical for improved OR metrics, including cancellation rates. Level of evidencelevel IV.

EP-488 Pre-operative electronic checklists as a systematic method to improve patient care

AimsThe COVID-19 pandemic has resulted in major changes in pre-operative assessment, as consultations became conducted over the telephone, and pre-operative tests carried out a few days before surgery to coincide with the COVID testing visit. This increased the chances for preoperative tests to be missed. A recent audit in our unit revealed missed investigations just before surgery. A checklist was introduced to identify issues early and help reduce avoidable delays.MethodsAn audit was performed for completeness of preoperative preparations. A pre-operative checklist was created to include pre-operative investigation reports, routine laboratory results, proof of COVID-19 swabs and vaccination records, correct details on the theatre lists, signed consent forms with clearly visible patient marking. The checklist was launched and the team, including doctors and nurses, were educated on its value in improving patient care.ResultsThe implementation of electronic pre-operative checklists resulted in an immediate improvement of care, with preliminary results showing issues with a potential of causing delays being promptly identified and addressed. Late identification of issues could not be entirely avoided; however, this was discussed with team members, further education was provided, and data collection continues, to ensure good practice is sustained.ConclusionCOVID-19 has reduced the time for hospital visit and face to face interactions, but this created the opportunity for missed tests and processes leading to delays and cancellation of surgery. The checklist in our case has proven useful in identifying issues early and promptly managing potential delays in patient care.

Magnitude and reasons of surgery cancellation among elective surgical cases in Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia, 2021

BackgroundCancellations of cases are common; most of those cancellations are due to avoidable causes. It is a major cause of psychological trauma for patients and their families. Although little is known in Ethiopia, the aim of this study is aimed to assess the prevalence and the cause of elective surgery cancellation.MethodsA cross-sectional prospective study design was conducted on 326 patients scheduled for elective surgery from October 1 to December 1st. All consecutive elective surgical cases scheduled during the study period were included in the study. Data were collected using a prepared and pretested questionnaire and entered into SPSS version 23 for analysis. The result of the study was reported in the form of text, tables, and graphs.ResultDuring the study, 326 patients were scheduled for elective surgery, among those, 83(25.6%) of surgery was canceled. Patient-related (31.32%) and administrative-related (26.5%) factors were the two most causes of cancellation.ConclusionPatient-related and administrative-related factors were the leading causes of cancellation of elective surgical operations in our hospital. Concerned bodies should bring a sustainable change and improvement to prevent unnecessary cancellations and enhance cost-effectiveness through communications, careful planning and efficient utilization of the available hospital resources.

Contributing Factors of Elective Surgical Case Cancellation: A Cross- Sectional Descriptive Study

Introduction: Elective surgical case cancellation refers to a scheduled surgical procedure that not performed on a given day. Cancellation of elective surgical operation recognized as a major cause of emotional trauma to patients as well as their families. It has been a long-standing problem for healthcare organizations across the world. Methods: This was a cross-sectional observational study conducted from September 01 to November 30, 2021 for a period of three months in a 750-bedded tertiary care hospital, Kathmandu. A cancelled procedure was defined as a patient’s name appearing on the list for surgical operations but the operation not being performed on the scheduled date. Patients scheduled for surgical procedures were recruited into this study by the principal investigator and research assistants on the day prior to their operation. Results: Of total 600 patients scheduled for elective procedures over a period of three months, the prevalence of cancellation of elective surgical procedures was found to be 15.33 % (n=92). Of the examined surgical specialties, the cancellation prevalence was highest in GI and HPB at 40.9% (n =47), closely followed by Urosurgery at 31(33.6%), general surgery17(18.47%), plastics, Paediatric surgery 5(5.4%) and burn and plastics surgery 2 (2.1%) having the least cancellationrate at 2(2.1%) which was statistically significant (p value&lt;0.05). Conclusions:Inadequate preoperative preparation, prioritized emergency cases and equipment shortages are the common causes of elective surgical cancellations.

Is menstruation a valid reason to postpone cardiac surgery?

ABSTRACTBackground:Cancellation of any scheduled surgery is a significant drain on health resources and potentially stressful for patients. It is frequent in menstruating women who are scheduled to undergo open heart surgery (OHS), based on the widespread belief that it increases surgical and menstrual blood loss.Aims:The aim of this study was to evaluate blood loss in women undergoing OHS during menstruation.Settings and Design:A prospective, matched case-control study which included sixty women of reproductive age group undergoing OHS.Patients and Methods:The surgical blood loss was compared between women who were menstruating (group-M; n = 25) and their matched controls, i.e., women who were not menstruating (group-NM; n = 25) at the time of OHS. Of the women in group M, the menstrual blood loss during preoperative (subgroup-P) and perioperative period (subgroup-PO) was compared to determine the effect of OHS on menstrual blood loss.Results:The surgical blood loss was comparable among women in both groups irrespective of ongoing menstruation (gr-M = 245.6 ± 120.1 ml vs gr-NM = 243.6 ± 129.9 ml, P value = 0.83). The menstrual blood loss was comparable between preoperative and perioperative period in terms of total menstrual blood loss (gr-P = 36.8 ± 4.8 ml vs gr-PO = 37.7 ± 5.0 ml, P value = 0.08) and duration of menstruation (gr-P = 4.2 ± 0.6 days vs gr-PO = 4.4 ± 0.6 days, P value = 0.10).Conclusion:Neither the surgical blood loss nor the menstrual blood loss is increased in women undergoing OHS during menstruation.

Prevalence of surgery cancelation and challenges in restarting elective surgery in the pandemic: A cross-sectional study

ObjectivesThe COVID-19 pandemic caused primary disruption of health services, especially to elective surgery. As the pandemic goes in waves of high and low infection rates in a country, restarting elective surgery must be dynamic while balancing patients’ needs, staff safety and the hospital capacity. We aim to report the prevalence of elective surgery and minimally invasive procedures cancelation due to positive Covid-19 screening and describe steps in restarting elective cases after the third wave of Covid-19 infection. MethodsThis study was a descriptive cross-sectional study in Indonesia's tertiary referral and teaching hospital from January to September 2021. Subjects were patients scheduled for elective surgery or minimally invasive procedures from our outpatient clinic. Subjects were screened for SARS-CoV-2 using real-time polymerase chain reaction (rRT-PCR) 24-48 hours before scheduled surgery or intervention. Data was taken from the hospital information system and the central operating theatre online surgical list. Statistical analysis is presented in percentage. ResultsThere were 5286 subjects identified for the study, and 3088 were included with an available PCR result from the outpatient department. The average elective cancelation rate was 7.4%, and the highest cancelation was on August 2021, with 14.7%. All subjects with positive results were asymptomatic, with more than 90% cycle time rRT-PCR above 30. ConclusionElective surgery cancelation can reflect a trend in community infection, and monitoring its values is crucial for saving elective surgery plans during a pandemic.

Cancellations and delays of emergent orthopedic operations at a Canadian level 1 trauma centre.

Background:Day-of surgery cancellation (DOSC) is considered to be a very inefficient use of hospital resources and results in emotional stress for the patient. To examine opportunities to minimize the incidence of preventable cancellations — an indicator of quality of care — we assessed the incidence of and reasons for DOSCs over 3 months among inpatients and outpatients at a trauma orthopedic service.Methods:This was a prospective study of 2 cohorts of patients, inpatients and outpatients, scheduled for emergent orthopedic surgery at a Canadian tertiary level 1 trauma centre from Jan. 1 to Mar. 31, 2020. Patient demographic characteristics, injury characteristics, delays until surgery and reasons for DOSCs were recorded.Results:A total of 185 patients (100 males and 85 females with a mean age of 54 yr) were included in the study. There were 98 outpatients and 87 inpatients. Seventy-five (40%) of the scheduled procedures in the outpatient group and 34 (30%) of those in the inpatient group were cancelled. In both groups, more than 85% of the cancellations were because of prioritization of a more urgent orthopedic or nonorthopedic surgical case. The average operative delay for the outpatient group was 11.4 days, compared to 3.8 days for the inpatient group (p < 0.001).Conclusion:High DOSC rates were observed among both outpatients and inpatients. The main reason for delaying surgery was prioritization of a more urgent surgical case. Providing the orthopedic trauma service with a dedicated OR opened 6 days per week, along with extended hours of OR services to 1700 daily, might be effective at minimizing DOSCs.

Analysis of the incidence and reasons of the same-day cancellation of non-cataract ophthalmic ambulatory surgery

Objective: To investigate the incidence and reasons of the same-day cancellation of non-cataract ophthalmic ambulatory surgery, and to provide a basis for further improvement of the medical quality of ophthalmic ambulatory surgery. Methods: The data of the appointment for ophthalmic ambulatory surgeries from December 1, 2020 to November 30, 2021, including the patient's general condition, disease diagnosis, proposed surgical arrangement, anesthesia method and the completion of the surgeries, were collected through the electronic medical record management system in Beijing Tongren Hospital, Capital Medical University. The total number and incidence of cancelled surgeries registered in the surgical center were analyzed, the incidence of cancelled surgeries of different ages, sexes, subspecialty surgical types, anesthesia methods, patient sources were analyzed, and the reasons for surgical cancellation were further analyzed. Results: A total of 10, 595 non-cataract ophthalmic day surgeries were applied, of which 827 were temporarily cancelled on the day of surgery, with a cancellation rate of 7.8%. The difference in the same-day surgery cancellation rate at different ages was statistically significant (P<0.001), of which the surgery cancellation rate in toddler and infants was the lowest, which was 2.1% (23/1 110) and 3.4% (2/59), respectively, while the surgery cancellation rate was the highest in elderly patients over 75 years old, at 10.4% (48/462). There was a statistically significant difference in surgical cancellation rates among different sub-specialties (P<0.001), with the lowest surgical cancellation rate in the tumor sub-specialty at 4.5% (33/732), while the corneal sub-specialty had the highest surgical cancellation rate at 14.3% (40/280), followed by the plastic sub-specialty with 11.8% (153/1 297). There were no statistically significant differences in the rate of surgical cancellation between different sexes, anesthesia methods or patients' home address (all P>0.05). The most common reason for same-day surgery cancellation was the absence of the patient on the day of surgery (49.7%, 479/827), followed by changes in the patient's general condition (18.4%, 152/827), and inadequate preoperative preparation (6.0%, 50/827). 64.3% (532/827) of the same-day surgical cancellations were considered to have been avoided by enhancing preoperative communication, consultation and management. Conclusions: The same-day cancellation rate of ambulatory surgery in non-cataract ophthalmology is 7.8%, of which the cancellation rate in elderly patients and in less invasive surgery are higher. The absence of the patient on the same day and the change of the patient's condition are the main reasons for the cancellation of surgery on the same day, and most of them are avoidable.

Impact of COVID-19 pandemic in surgical training of Junior Residents in general surgery

BackgroundThe pandemic caused by SARS-CoV2 has had a huge impact on our health system. Due to both cancellation of elective surgery and restructuring in departments at most medical centers, surgical residents face a potential training deficit in their specialty.This study aims to objectively analyze and quantify the impact of the pandemic on the surgical activity of residents, in the setting of emergency and elective surgery, to assess whether this period has really supposed a training deficit. Material and methodsA descriptive analysis is proposed, comparing the number of procedures performed by residents of our department during the year prior to the pandemic and during the pandemic, clustering them into different subgroups. ResultsThe results give an optimistic outlook. In the first place, in elective surgery, despite the lower procedures performed in absolute numbers, the proportional participation of residents in the scheduled surgeries increased in all the subgroups analyzed, finding statistically significant differences and finally approaching the total number of procedures in both periods, without relevant differences in the comparison. As for emergency surgery, residents also increased their proportional participation in most subgroups, in this case reaching more total procedures, even in absolute numbers. ConclusionTherefore, the results seem to indicate that the teaching effort made by staff surgeons of the department has managed to palliate, in most of the subgroups analyzed, the decrease in surgical activity that the pandemic has produced, so, at least in the area of surgical practice, the impact of the pandemic has probably been reduced comparing to previous expectations.